Provider Demographics
NPI:1881755916
Name:BERRY, BENJAMIN J (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:J
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HOAWAA WAY
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1600
Mailing Address - Country:US
Mailing Address - Phone:808-283-7755
Mailing Address - Fax:808-879-3356
Practice Address - Street 1:30 HOAWAA WAY
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-1600
Practice Address - Country:US
Practice Address - Phone:808-283-7755
Practice Address - Fax:808-879-3356
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10631207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA80256Medicare UPIN