Healthcare Provider Details

I. General information

NPI: 1477175867
Provider Name (Legal Business Name): RAISSA ANN BERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 BEAVER AVE
PITTSBURGH PA
15233-2360
US

IV. Provider business mailing address

1425 BEAVER AVE
PITTSBURGH PA
15233-2360
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-8415
  • Fax: 412-322-9224
Mailing address:
  • Phone: 412-322-8415
  • Fax: 412-322-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS023453
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: