Provider Demographics
NPI:1669550307
Name:BERRY, CAROL DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DAWN
Last Name:BERRY
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 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-6262
Mailing Address - Fax:
Practice Address - Street 1:4150 V STREET, SUITE 6500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-4671
Practice Address - Country:US
Practice Address - Phone:916-734-8516
Practice Address - Fax:916-734-7766
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45158207RI0200X
CAG-45158207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G451580Medicaid
CA00G451580Medicaid
00G451580Medicare ID - Type Unspecified