Provider Demographics
NPI:1841251824
Name:BERK, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:BERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27-29 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2414
Mailing Address - Country:US
Mailing Address - Phone:508-753-2159
Mailing Address - Fax:508-753-5784
Practice Address - Street 1:27-29 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2414
Practice Address - Country:US
Practice Address - Phone:508-753-2159
Practice Address - Fax:508-753-5784
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150108207W00000X
CT045654207W00000X
MA54627207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001456541Medicaid
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherRAILROAD MEDICARE
0800299OtherEVERCARE
5238488OtherAETNA US HEALTHCARE
042472266OtherONE HEALTH PLAN
NY52833AOtherMEDICARE PTAN
1059575OtherFIRST HEALTH
2184329OtherCIGNA HEALTH PLAN
NY52833AOtherMEDICARE PTAN
042472266OtherONE HEALTH PLAN