Provider Demographics
NPI:1982674479
Name:BERKOWITZ, SHELLY Z (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:Z
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LOCUST ST
Mailing Address - Street 2:#5
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2045
Mailing Address - Country:US
Mailing Address - Phone:413-582-0456
Mailing Address - Fax:413-582-0458
Practice Address - Street 1:51 LOCUST ST
Practice Address - Street 2:#5
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2045
Practice Address - Country:US
Practice Address - Phone:413-582-0456
Practice Address - Fax:413-582-0458
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ18360OtherBLUE CROSS AND BLUE SHIEL
MA00000008344OtherBMC HEALTHNET
MA10248601OtherCIGNA
MA71934OtherHARVARD
MA080543OtherTUFTS
MA24677OtherHEALTH NEW ENGLAND
MA3184790Medicaid
MD101485OtherAETNA
MA805431OtherCONNECTICARE
MA805431OtherCONNECTICARE
MA00000008344OtherBMC HEALTHNET