Provider Demographics
NPI:1912962358
Name:BERENS, ANDREW JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:BERENS
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 1:236 NORTH WASHINGTON STREET
Mailing Address - Street 2:FAMILY MEDICINE OF BERKELEY SPRINGS INC
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411
Mailing Address - Country:US
Mailing Address - Phone:304-258-4408
Mailing Address - Fax:304-258-6858
Practice Address - Street 1:236 NORTH WASHINGTON STREET
Practice Address - Street 2:FAMILY MEDICINE OF BERKELEY SPRINGS INC
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411
Practice Address - Country:US
Practice Address - Phone:304-258-4408
Practice Address - Fax:304-258-6858
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1801930000Medicaid
WVBE0782363Medicare ID - Type Unspecified
WV1801930000Medicaid