Provider Demographics
NPI:1639181357
Name:BERAHO, JOSEPH BYAMUGISHA (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BYAMUGISHA
Last Name:BERAHO
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 1:1417 WALTER ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4130
Mailing Address - Country:US
Mailing Address - Phone:903-757-9394
Mailing Address - Fax:
Practice Address - Street 1:1205 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5649
Practice Address - Country:US
Practice Address - Phone:903-247-8262
Practice Address - Fax:903-247-8274
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine