Provider Demographics
NPI:1477558591
Name:BERRY, THOMAS NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NELSON
Last Name:BERRY
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 1:1300 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6937
Mailing Address - Country:US
Mailing Address - Phone:410-742-8801
Mailing Address - Fax:410-742-8816
Practice Address - Street 1:1300 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6937
Practice Address - Country:US
Practice Address - Phone:410-742-8801
Practice Address - Fax:410-742-8816
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-03-26
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
MDD0005689207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0400912 00Medicaid
D74517Medicare UPIN
MD0400912 00Medicaid