Provider Demographics
NPI:1790764009
Name:BERRY, WAYNE J II (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:BERRY
Suffix:II
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 1:199 GLENDOBBIN LANE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603
Mailing Address - Country:US
Mailing Address - Phone:540-535-1645
Mailing Address - Fax:
Practice Address - Street 1:759 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1127
Practice Address - Country:US
Practice Address - Phone:540-459-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35098207Q00000X
VA0101240108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891518AMedicaid
VA010321310Medicaid
VA1790764009OtherNPI
NC1518AOtherBCBS
VA540490687003OtherTRICARE
NC891518AMedicaid