Provider Demographics
NPI:1750448619
Name:KEVIN J. BERRY, MD
Entity Type:Organization
Organization Name:KEVIN J. BERRY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-794-0234
Mailing Address - Street 1:380 MERRIMACK ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5870
Mailing Address - Country:US
Mailing Address - Phone:978-794-0234
Mailing Address - Fax:978-794-0560
Practice Address - Street 1:380 MERRIMACK ST
Practice Address - Street 2:STE. 2D
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5870
Practice Address - Country:US
Practice Address - Phone:978-794-0234
Practice Address - Fax:978-794-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD24023Medicare ID - Type Unspecified
NHRE8532Medicare PIN
NHRE8532Medicare ID - Type Unspecified
MAD24023Medicare PIN