Provider Demographics
NPI:1265474670
Name:INTERNAL MEDICINE OF BERWICK PC INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF BERWICK PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-752-5056
Mailing Address - Street 1:751 E 16TH ST
Mailing Address - Street 2:SUITE300
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2321
Mailing Address - Country:US
Mailing Address - Phone:570-752-5056
Mailing Address - Fax:
Practice Address - Street 1:751 E 16TH ST
Practice Address - Street 2:SUITE300
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2321
Practice Address - Country:US
Practice Address - Phone:570-752-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067594L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075190570002Medicaid
PA02305400OtherCAPITAL BLUE CROSS
PA1533376OtherGATEWAY
PA1348169OtherHIGHMARK BLUE SHIELD
PA221084OtherFIRST PRIORITY HEALTH
PA010093500OtherBLACK LUNG
PA02305400OtherCAPITAL BLUE CROSS
PA077794Medicare PIN