Provider Demographics
NPI:1952454928
Name:BERKOWITZ, ANDREW MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARK
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:725 LISA CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2223
Mailing Address - Country:US
Mailing Address - Phone:215-947-6143
Mailing Address - Fax:215-947-6274
Practice Address - Street 1:1718 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4213
Practice Address - Country:US
Practice Address - Phone:215-947-6143
Practice Address - Fax:215-947-6274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036462E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0081708000OtherKEYSTONE HEALTH PLAN
PA0011215100001Medicaid
PA0081708000OtherBLUE SHIELD AND HIGHMARK
PA0011215100001Medicaid
PA0081708000OtherKEYSTONE HEALTH PLAN