Provider Demographics
NPI:1326373598
Name:BERRY, LORI MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MICHELLE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2102 TREASURE HILLS BLVD.
Mailing Address - Street 2:#3.144.06
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:4150 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1803
Practice Address - Country:US
Practice Address - Phone:956-296-1960
Practice Address - Fax:956-381-5397
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2830208000000X
TXFTL46605208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392864001Medicaid
TXH08KQ93201OtherBCBS