Provider Demographics
NPI:1013967058
Name:BERRY, JOHN F JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-0666
Mailing Address - Country:US
Mailing Address - Phone:508-775-3177
Mailing Address - Fax:508-775-0895
Practice Address - Street 1:1949 ROUTE 28
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-3119
Practice Address - Country:US
Practice Address - Phone:508-775-3177
Practice Address - Fax:508-775-0895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA039341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2046334Medicaid
MAL01005Medicare ID - Type Unspecified
MA2046334Medicaid