Healthcare Provider Details

I. General information

NPI: 1144229170
Provider Name (Legal Business Name): MICHELE BARBARA BERKELEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR STE 302
ARLINGTON VA
22205
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2693
US

V. Phone/Fax

Practice location:
  • Phone: 703-816-4152
  • Fax: 703-527-1169
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number042792
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD45517
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD21138
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1153
License Number StateVI
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101250766
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: