Healthcare Provider Details

I. General information

NPI: 1104044379
Provider Name (Legal Business Name): JOSEPH BERK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9199 REISTERSTOWN RD SUITE 207A
OWINGS MILLS MD
21117-4520
US

IV. Provider business mailing address

9199 REISTERSTOWN RD SUITE 207A
OWINGS MILLS MD
21117-4520
US

V. Phone/Fax

Practice location:
  • Phone: 410-654-4525
  • Fax:
Mailing address:
  • Phone: 410-654-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BERK
Title or Position: M.D./OWNER
Credential:
Phone: 410-933-6423