Healthcare Provider Details

I. General information

NPI: 1700994076
Provider Name (Legal Business Name): DENNIS J. BERARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 PLEASANT ST
ATTLEBORO MA
02703-2442
US

IV. Provider business mailing address

159 PLEASANT ST
ATTLEBORO MA
02703-2442
US

V. Phone/Fax

Practice location:
  • Phone: 508-223-2474
  • Fax: 508-431-1515
Mailing address:
  • Phone: 508-223-2474
  • Fax: 508-431-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number155077
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: