Provider Demographics
NPI:1851316137
Name:BERHANE, REZENE (MD)
Entity Type:Individual
Prefix:DR
First Name:REZENE
Middle Name:
Last Name:BERHANE
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 1:31 PINE STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTHFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:508-623-3700
Mailing Address - Fax:508-623-3701
Practice Address - Street 1:31 PINE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTHFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-623-3700
Practice Address - Fax:508-623-3701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3154246Medicaid
MA3154246Medicaid
MAJ16715Medicare ID - Type Unspecified