Provider Demographics
NPI:1902857485
Name:BERKS VASCULAR INSTITUTE, PC
Entity Type:Organization
Organization Name:BERKS VASCULAR INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:P.V. PATHANJALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-376-8118
Mailing Address - Street 1:2494 BERNVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9454
Mailing Address - Country:US
Mailing Address - Phone:610-376-8118
Mailing Address - Fax:610-376-8141
Practice Address - Street 1:2494 BERNVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9454
Practice Address - Country:US
Practice Address - Phone:610-376-8118
Practice Address - Fax:610-376-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA781461Medicare ID - Type Unspecified