Provider Demographics
NPI:1265439798
Name:AVELLA, BERARD NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:BERARD
Middle Name:NICHOLAS
Last Name:AVELLA
Suffix:
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 1:2913 WINDMILL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1680
Mailing Address - Country:US
Mailing Address - Phone:610-678-8800
Mailing Address - Fax:610-678-8286
Practice Address - Street 1:2913 WINDMILL RD STE 7
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1680
Practice Address - Country:US
Practice Address - Phone:610-678-8800
Practice Address - Fax:610-678-8286
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010911E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02520600OtherB/C WESTERN BERKS MEDIC
PA96467OtherHEALTHAMERICA ID #
PA01571701OtherBLUE CROSS ID #
PA631777OtherB/S WESTERN BERKS MEDIC
PA113042OtherBLUE SHIELD ID #
PA01571701OtherBLUE CROSS ID #
PAB36916Medicare UPIN
PA113042Medicare ID - Type UnspecifiedMC PHYSICIAN ID #