Provider Demographics
NPI:1326145772
Name:BERRIOS, MADELAINE (MD)
Entity Type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0519
Mailing Address - Country:US
Mailing Address - Phone:787-857-8383
Mailing Address - Fax:787-857-4848
Practice Address - Street 1:CARR 152 KM 2.3
Practice Address - Street 2:BO. QUEBRADILLAS
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-0519
Practice Address - Country:US
Practice Address - Phone:787-857-8383
Practice Address - Fax:787-857-4848
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR96346Medicare ID - Type Unspecified