Provider Demographics
NPI:1770554131
Name:BERCOVITCH, ANNE B (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:B
Last Name:BERCOVITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:978-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:148 W RIVER ST STE 1B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-273-9310
Practice Address - Fax:401-273-1270
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38330207NI0002X
RIMD12674207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2062704Medicaid
MAA53877Medicare UPIN
MA2062704Medicaid