Healthcare Provider Details

I. General information

NPI: 1295715704
Provider Name (Legal Business Name): MARY-EMMA BERES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CHATHAM MEDICAL PARK
ELKIN NC
28621-2482
US

IV. Provider business mailing address

600 CHATHAM MEDICAL PARK
ELKIN NC
28621-2482
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-4819
  • Fax: 336-835-8207
Mailing address:
  • Phone: 336-835-4819
  • Fax: 336-835-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101057835
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9800784
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: