Provider Demographics
NPI:1740636059
Name:BERRY, SAMEER (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:SAMEER
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:751 S WEIR CANYON RD # 157-555
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1962
Mailing Address - Country:US
Mailing Address - Phone:714-904-5064
Mailing Address - Fax:
Practice Address - Street 1:311 E 79TH ST STE 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0999
Practice Address - Country:US
Practice Address - Phone:212-996-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314724207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty