Healthcare Provider Details

I. General information

NPI: 1659790517
Provider Name (Legal Business Name): ANDREW BERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE
DENVER CO
80218
US

IV. Provider business mailing address

PO BOX 5406
DENVER CO
80217-5406
US

V. Phone/Fax

Practice location:
  • Phone: 303-839-7111
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0058414
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0058414
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: