Provider Demographics
NPI:1891465449
Name:BERRY, JULIE ANNE
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:COLORECTAL DEPARTEMENT A30 9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-399-4758
Mailing Address - Fax:
Practice Address - Street 1:COLORECTAL DEPARTMENT 9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.251912282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital