Provider Demographics
NPI:1881878098
Name:DENNIS P. BERK, M.D., P.C.
Entity type:Organization
Organization Name:DENNIS P. BERK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-1524
Mailing Address - Street 1:131 OLD ROAD TO NINE ACRE CORNER
Mailing Address - Street 2:JOHN CUMING BUILDNG SUITE 550
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-1524
Mailing Address - Fax:978-369-9390
Practice Address - Street 1:131 OLD ROAD TO NINE ACRE CORNER
Practice Address - Street 2:JOHN CUMING BUILDNG SUITE 550
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-1524
Practice Address - Fax:978-369-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA029460OtherTUFTS HEALTH PLAN
MA64674OtherHARVARD PILGRIM HEALTHCAR
MA9707913Medicaid
MAM11914OtherBLUE CROSS BLUE SHIELD
MAM11914Medicare UPIN