Provider Demographics
NPI:1851374276
Name:BERKOWITZ, LORI R (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT STREET YAW 4
Practice Address - Street 2:VINCENT OBGYN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-7635
Practice Address - Fax:617-726-4803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA154062207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA154062OtherTUFTS HEALTH PLAN
MA3171248Medicaid
MAJ17859OtherBCBS MA
MA154062OtherTUFTS HEALTH PLAN
G50635Medicare UPIN