Healthcare Provider Details

I. General information

NPI: 1356474043
Provider Name (Legal Business Name): DAVID P. BERRY, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303-4201
US

IV. Provider business mailing address

1330 BOILING SPRINGS RD SUITE 2400
SPARTANBURG SC
29303-4201
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-5312
  • Fax:
Mailing address:
  • Phone: 864-583-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7904
License Number StateSC

VIII. Authorized Official

Name: GWEN M LANFORD
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 864-583-5312