Healthcare Provider Details

I. General information

NPI: 1376869586
Provider Name (Legal Business Name): BERRYVILLE MEDICAL ASSOCIATES PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S CHURCH ST
BERRYVILLE VA
22611-1369
US

IV. Provider business mailing address

136 LINDEN DR STE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-4811
  • Fax:
Mailing address:
  • Phone: 540-678-3588
  • Fax: 540-678-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: SHERIF Z KAISER
Title or Position: OWNER
Credential: MD
Phone: 540-955-4811