Healthcare Provider Details

I. General information

NPI: 1508969726
Provider Name (Legal Business Name): BERRYVILLE MEDICAL ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S CHURCH STREET
BERRYVILLE VA
22611-1369
US

IV. Provider business mailing address

136 LINDEN DR SUITE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 540-955-4811
  • Fax: 540-955-0976
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: MD/OWNER
Credential: MD
Phone: 540-955-4811