Provider Demographics
NPI:1972853604
Name:BERKSHIRE MOBILE MEDICINE, P.C.
Entity Type:Organization
Organization Name:BERKSHIRE MOBILE MEDICINE, P.C.
Other - Org Name:GREYLOCK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:413-445-6800
Mailing Address - Street 1:20 WILLIAMSTOWN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LANESBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9548
Mailing Address - Country:US
Mailing Address - Phone:413-445-6800
Mailing Address - Fax:413-707-4959
Practice Address - Street 1:20 WILLIAMSTOWN RD STE 4
Practice Address - Street 2:
Practice Address - City:LANESBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01237-9548
Practice Address - Country:US
Practice Address - Phone:413-445-6800
Practice Address - Fax:413-707-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156843207R00000X
MA1520363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty