Healthcare Provider Details

I. General information

NPI: 1417191545
Provider Name (Legal Business Name): MARCY L. BERRY, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HEDGCOXE RD SUITE 190
PLANO TX
75025-3156
US

IV. Provider business mailing address

2100 HEDGCOXE RD SUITE 190
PLANO TX
75025-3156
US

V. Phone/Fax

Practice location:
  • Phone: 972-208-8668
  • Fax: 972-208-3186
Mailing address:
  • Phone: 972-208-8668
  • Fax: 972-208-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK8005
License Number StateTX

VIII. Authorized Official

Name: DR. MARCY L BERRY
Title or Position: PHYSICIAN / OWNER
Credential: M.D.
Phone: 972-208-8668