Provider Demographics
NPI:1821060583
Name:KWAKYE-BERKO, DANIELLE RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:RENEE
Last Name:KWAKYE-BERKO
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 1:511 RUIN CREEK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5919
Mailing Address - Country:US
Mailing Address - Phone:252-436-0440
Mailing Address - Fax:252-436-0281
Practice Address - Street 1:511 RUIN CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5919
Practice Address - Country:US
Practice Address - Phone:252-436-0440
Practice Address - Fax:252-436-0281
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201315207R00000X
NC9700627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02102192Medicaid
NYG56231Medicare UPIN
NY1146109OtherWELLCARE
0492971OtherINDEPENDENT HEALTH ASSOCIATION
NYP01585612OtherMEDICARE RAILROAD
NY02102192Medicaid
NYJ400245272Medicare PIN
NYRA6191Medicare PIN
NY1562041OtherCIGNA