Provider Demographics
NPI:1700577707
Name:BERRY, BETH REESE (DMSC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:REESE
Last Name:BERRY
Suffix:
Gender:F
Credentials:DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-2083
Mailing Address - Country:US
Mailing Address - Phone:540-535-8183
Mailing Address - Fax:
Practice Address - Street 1:553 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-2083
Practice Address - Country:US
Practice Address - Phone:540-535-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant