Provider Demographics
NPI:1700821527
Name:DERMATOLOGY OF THE BERKSHIRES, P.C.
Entity Type:Organization
Organization Name:DERMATOLOGY OF THE BERKSHIRES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-663-6769
Mailing Address - Street 1:77 HOSPITAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2538
Mailing Address - Country:US
Mailing Address - Phone:413-663-6769
Mailing Address - Fax:413-663-6421
Practice Address - Street 1:77 HOSPITAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2538
Practice Address - Country:US
Practice Address - Phone:413-663-6769
Practice Address - Fax:413-663-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M21331Medicare ID - Type Unspecified
E54363Medicare UPIN