Provider Demographics
NPI:1306208905
Name:BERK, GREGORY IVAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:IVAN
Last Name:BERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CLAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2116
Mailing Address - Country:US
Mailing Address - Phone:925-719-3531
Mailing Address - Fax:
Practice Address - Street 1:133 CLAYBROOK RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MA
Practice Address - Zip Code:02030-2116
Practice Address - Country:US
Practice Address - Phone:925-719-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51814207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology