Healthcare Provider Details

I. General information

NPI: 1689714040
Provider Name (Legal Business Name): BERKSHIRE OSTEOPATHIC HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SUMMER ST SUITE 301
PITTSFIELD MA
01201-4624
US

IV. Provider business mailing address

42 SUMMER ST SUITE 301
PITTSFIELD MA
01201-4624
US

V. Phone/Fax

Practice location:
  • Phone: 413-442-0085
  • Fax: 413-464-9143
Mailing address:
  • Phone: 413-442-0085
  • Fax: 413-464-9143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number233633
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number233633
License Number StateMA

VIII. Authorized Official

Name: MARIA A HOLMAN
Title or Position: MA AND OFFICE MANAGER
Credential: MA
Phone: 413-442-0085