Provider Demographics
NPI:1326110768
Name:BERKSHIRE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:BERKSHIRE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHURTLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-499-8500
Mailing Address - Street 1:777 NORTH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4147
Mailing Address - Country:US
Mailing Address - Phone:413-499-8510
Mailing Address - Fax:413-499-8553
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-499-8510
Practice Address - Fax:413-499-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33453OtherMVP
MA687754OtherTUFTS
MA000000020924OtherHEALTHNET
MA7758OtherCDPHP
MAM17631OtherBCBS
MA9701567Medicaid
MACH5899OtherRAILROAD MEDICARE
MA33453OtherMVP
MA=========OtherUHC
MA=========OtherHEALTH NEW ENGLAND
MA000000020924OtherHEALTHNET
MA=========OtherGIC INDEMNITY
MACH5899OtherRAILROAD MEDICARE
MA9701567Medicaid
MA=========OtherHEALTH NEW ENGLAND