Healthcare Provider Details

I. General information

NPI: 1104154178
Provider Name (Legal Business Name): ERICA LIN BERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE NATIONAL NAVAL MEDICAL CENTER
BETHESDA MD
20889
US

IV. Provider business mailing address

8901 WISCONSIN AVE NATIONAL NAVAL MEDICAL CENTER
BETHESDA MD
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-2048
  • Fax:
Mailing address:
  • Phone: 301-295-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102202665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: