1013905066 NPI number — MARTA J BERIO MD

Table of content: MARTA J BERIO MD (NPI 1013905066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013905066 NPI number — MARTA J BERIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERIO
Provider First Name:
MARTA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERIO ALVAREZ
Provider Other First Name:
MARTA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013905066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33713-8815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-526-9135
Provider Business Mailing Address Fax Number:
727-526-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12170 SEMINOLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33778-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-586-5355
Provider Business Practice Location Address Fax Number:
727-526-4346
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME55209 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 258491300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com