Provider Demographics
NPI:1346208303
Name:BERWALD, ROSE ANN (MD)
Entity Type:Individual
Prefix:
First Name:ROSE ANN
Middle Name:
Last Name:BERWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 PARK ST
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-344-7673
Mailing Address - Fax:781-344-5955
Practice Address - Street 1:966 PARK ST C3
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3672
Practice Address - Country:US
Practice Address - Phone:781-344-7673
Practice Address - Fax:781-344-5955
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70519207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070519OtherTUFTS
MAJ08817OtherBLUE CROSS BLUE SHIELD MA
MA13564OtherHARVARD PILGRIM HEALTHCAR
32136OtherAETNA
MA0005929OtherNEIGHBORHOOD HEALTH PLAN
MA110047284/AMedicaid
MA0005929OtherNEIGHBORHOOD HEALTH PLAN
MA110047284/AMedicaid