Provider Demographics
NPI:1508821992
Name:BERRY, RICHARD GARTH (MD, FACP, FACGS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GARTH
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD, FACP, FACGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1527
Mailing Address - Country:US
Mailing Address - Phone:910-642-0300
Mailing Address - Fax:910-640-3327
Practice Address - Street 1:15 HILL PLZ STE A
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-4950
Practice Address - Country:US
Practice Address - Phone:910-642-0300
Practice Address - Fax:910-640-3327
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080190419OtherRAILROAD MEDICARE - INDIVIDUAL
NC110069099OtherPALMETTA GBA
NC4140662OtherAETNA
SCN36494Medicaid
SCNPB005OtherSOUTH CAROLINA MEDICAID
NC15212OtherOPTION BCBS- INDIVIDUAL
NC15212OtherBCBS STATE - INDIVIDUAL
NC0245HOtherFEDERAL BLUECROSS BLUESHIELD
NC0245HOtherBLUECROSS BLUESHIELD STATE
NC0245HOtherOPTION BLUECROSS BLUESHIELD
NC15212OtherBCBS - INDIVIDUAL
NC89013UYMedicaid
NC8915212OtherNC MEDICAID - INDIVIDUAL
NCCK5068OtherRAILROAD MEDICARE
NCN36494OtherSOUTH CAROLINA MEDICAID- INDIVIDUAL
NC216449OtherCOVENTRY HEALTH CARE PLAN
NC7067596009OtherCIGNA
NC0245HOtherBLUECROSS BLUESHIELD
NC141838016OtherTRICARE
NC141838016OtherUNITED HEALTHCARE
NC15212OtherFEDERAL BCBS- INDIVIDUAL
NC2183703FOtherMEDICARE - INDIVIDUAL
NC216449OtherCOVENTRY HEALTH CARE PLAN
NC7067596009OtherCIGNA
NCF11209Medicare UPIN