1487671145 NPI number — WESTERN BERKS MEDICAL ASSOCIATES

Table of content: (NPI 1487671145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487671145 NPI number — WESTERN BERKS MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN BERKS MEDICAL ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487671145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2913 WINDMILL RD STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SINKING SPRING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19608-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-678-8800
Provider Business Mailing Address Fax Number:
610-678-8286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2913 WINDMILL RD STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SINKING SPRING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19608-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-678-8800
Provider Business Practice Location Address Fax Number:
610-678-8286
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AVELLA
Authorized Official First Name:
BERARD
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-678-8800

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD010911E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113042 . This is a "B/S BERARD N. AVELLA, MD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 631777 . This is a "B/S WESTERN BERKS MED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01571701 . This is a "B/C BERARD N. AVELLA, MD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02520600 . This is a "B/C WESTERN BERKS MED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1265439798 . This is a "NPI FOR BERARD AVELLA, MD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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