Healthcare Provider Details

I. General information

NPI: 1871569517
Provider Name (Legal Business Name): ELIZA BERKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 ELEANOR CT
NORFOLK VA
23508-1009
US

IV. Provider business mailing address

PO BOX 936
NORFOLK VA
23501-0936
US

V. Phone/Fax

Practice location:
  • Phone: 704-685-2945
  • Fax:
Mailing address:
  • Phone: 757-573-6033
  • Fax: 757-624-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20050184
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number0101241848
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: