Provider Demographics
NPI:1265769392
Name:BERKOWITZ, SETH A (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:A
Last Name:BERKOWITZ
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 1:5034 OLD CLINIC BLDG CB #7110
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:385 BROADWAY
Practice Address - Street 2:MGH BROADWAY PRIMARY CARE
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3033
Practice Address - Country:US
Practice Address - Phone:781-485-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250520207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program