1871569517 NPI number — DR. ELIZA BERKLEY MD

Table of content: DR. ELIZA BERKLEY MD (NPI 1871569517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871569517 NPI number — DR. ELIZA BERKLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERKLEY
Provider First Name:
ELIZA
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
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:
1871569517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23501-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-573-6033
Provider Business Mailing Address Fax Number:
757-624-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6433 ELEANOR CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23508-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-685-2945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2006

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: 207VX0000X , with the licence number:  20050184 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 0101241848 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10265084 . This is a "OPTIMA/SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 303352 . This is a "ANTHEM FF" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "VIRGINIA PREMIER HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 303361 . This is a "ANTHEM FC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1871569517 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5907694 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PAR . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 07694 . This is a "NC BC/BS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1871569517 . This is a "TRICARE EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 303374 . This is a "ANTHEM JCM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1871569517 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PAR . This is a "CORVEL/CORCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 303377 . This is a "ANTHEM COLLEY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "USA MANAGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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