Healthcare Provider Details

I. General information

NPI: 1881695179
Provider Name (Legal Business Name): JOSEPH WILLIAM BERKOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE
BALTIMORE MD
21215-5228
US

IV. Provider business mailing address

8511 ARBORWOOD RD
BALTIMORE MD
21208-1503
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5700
  • Fax:
Mailing address:
  • Phone: 410-484-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0000683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: