Provider Demographics
NPI:1295715704
Name:BERES, MARY-EMMA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY-EMMA
Middle Name:
Last Name:BERES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CHATHAM MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2482
Mailing Address - Country:US
Mailing Address - Phone:336-835-4819
Mailing Address - Fax:336-835-8207
Practice Address - Street 1:600 CHATHAM MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2482
Practice Address - Country:US
Practice Address - Phone:336-835-4819
Practice Address - Fax:336-835-8207
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057835207QA0505X
NC9800784207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005610681Medicaid
VA690573GMedicaid
VA005610681Medicaid
VA080007351Medicare ID - Type Unspecified
NC2262114AMedicare ID - Type Unspecified