Provider Demographics
NPI:1700080454
Name:ROSEANN BERWALD, MD
Entity Type:Organization
Organization Name:ROSEANN BERWALD, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-580-1508
Mailing Address - Street 1:370 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1303
Mailing Address - Country:US
Mailing Address - Phone:508-580-1508
Mailing Address - Fax:
Practice Address - Street 1:370 OAK ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1303
Practice Address - Country:US
Practice Address - Phone:508-580-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70519207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19204OtherBLUE CROSS BLUE SHIELD MA