Provider Demographics
NPI:1942298971
Name:BERENBERG, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BERENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:781-682-0600
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:781-682-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA45619207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
23047OtherHARVARD PILGRIM HEALTHCAR
MA0158623Medicaid
MA000000020777OtherBOSTON HEALTH NET
290014541OtherRAILROAD MEDICARE
B10159102OtherCIGNA HEALTHCARE
MA0004320OtherNEIGHBORHOOD HEALTH PLAN
3124OtherAETNA/US HEALTHCARE
MD48 - 00036OtherUNITED HEALTHCARE OF NE
702305OtherTUFTS ASSOCIATED HEALTH P
E05697OtherBLUE CROSS/BLUE SHIELD
702305OtherTUFTS ASSOCIATED HEALTH P
B10159102OtherCIGNA HEALTHCARE