Provider Demographics
NPI:1780622217
Name:BERKSHIRE PODIATRY CENTER, LTD
Entity type:Organization
Organization Name:BERKSHIRE PODIATRY CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-373-4154
Mailing Address - Street 1:50 BERKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1219
Mailing Address - Country:US
Mailing Address - Phone:610-373-4154
Mailing Address - Fax:610-373-8651
Practice Address - Street 1:50 BERKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1219
Practice Address - Country:US
Practice Address - Phone:610-373-4154
Practice Address - Fax:610-373-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PW450654Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER