Provider Demographics
NPI:1457960171
Name:BERRY, MEAGHANELIZABETH VIOLA
Entity Type:Individual
Prefix:
First Name:MEAGHANELIZABETH
Middle Name:VIOLA
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 LARCHMONT RD APT 701
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5973
Mailing Address - Country:US
Mailing Address - Phone:860-208-9025
Mailing Address - Fax:
Practice Address - Street 1:4225 LARCHMONT RD APT 701
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5973
Practice Address - Country:US
Practice Address - Phone:860-208-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty