Provider Demographics
NPI:1497930218
Name:BERKOWITZ, BAYLA (CNM)
Entity Type:Individual
Prefix:
First Name:BAYLA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 TANEY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3751
Mailing Address - Country:US
Mailing Address - Phone:443-424-7846
Mailing Address - Fax:443-817-0491
Practice Address - Street 1:3501 TANEY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3751
Practice Address - Country:US
Practice Address - Phone:443-424-7846
Practice Address - Fax:443-817-0491
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR161702367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0161730Medicaid