Provider Demographics
NPI:1790782852
Name:BAKER-BERZANSKY, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BAKER-BERZANSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WATER ST
Mailing Address - Street 2:CENTRAL PLAZA
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6223
Mailing Address - Country:US
Mailing Address - Phone:978-556-0100
Mailing Address - Fax:978-556-0101
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:CENTRAL PLAZA
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6223
Practice Address - Country:US
Practice Address - Phone:978-556-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F71816Medicare UPIN
J14364Medicare UPIN
MA3118533Medicare ID - Type Unspecified