Provider Demographics
NPI:1740269760
Name:BERRY, GIRARD F (PA)
Entity type:Individual
Prefix:
First Name:GIRARD
Middle Name:F
Last Name:BERRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRENNER AVE
Mailing Address - Street 2:VETERAN AFFAIRS, PSYCHIATRY
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:1601 BRENNER AVE
Practice Address - Street 2:VETERAN AFFAIRS, PSYCHIATRY
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2515
Practice Address - Country:US
Practice Address - Phone:704-638-9000
Practice Address - Fax:336-277-9275
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000100827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2799656AMedicare ID - Type Unspecified
NCR49046Medicare UPIN