Provider Demographics
NPI:1801864566
Name:BERCOWITZ, HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
Last Name:BERCOWITZ
Suffix:
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 1:110 KINGSLEY LN STE 312
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4618
Mailing Address - Country:US
Mailing Address - Phone:757-889-4386
Mailing Address - Fax:757-889-5742
Practice Address - Street 1:110 KINGSLEY LN STE 312
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4618
Practice Address - Country:US
Practice Address - Phone:757-889-4386
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043800207P00000X, 207PE0005X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005846951Medicaid