Provider Demographics
NPI:1891145124
Name:BERBARA, RONY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONY
Middle Name:
Last Name:BERBARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RONY
Other - Middle Name:
Other - Last Name:BARBARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0920
Mailing Address - Fax:
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011097162084P0800X
MI43510382672084P0800X
MA2824312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4351038267OtherMEDICAL DOCTOR - EDUCATIONAL LIMITED
MI5315075935OtherPHARMACY CS-1