Provider Demographics
NPI:1821137100
Name:BERKOWITZ, BETH JO (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:JO
Last Name:BERKOWITZ
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 1:19198 DE HAVILLAND DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4041
Mailing Address - Country:US
Mailing Address - Phone:305-965-4530
Mailing Address - Fax:
Practice Address - Street 1:19198 DE HAVILLAND DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4041
Practice Address - Country:US
Practice Address - Phone:305-965-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC61701208000000X
IL036101064208000000X
FL89259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics