Provider Demographics
NPI:1639244072
Name:BERKSHIRE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BERKSHIRE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MALA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-442-8393
Mailing Address - Street 1:51 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6132
Mailing Address - Country:US
Mailing Address - Phone:413-442-8330
Mailing Address - Fax:413-442-8331
Practice Address - Street 1:51 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6132
Practice Address - Country:US
Practice Address - Phone:413-442-8330
Practice Address - Fax:413-442-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18950OtherBCBS
MAM21673Medicare ID - Type Unspecified