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General NPI Number Information
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NPI Number | 1043475932
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Entity Type | Organization
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Legal Business Name | BERKSHIRE COLON & RECTAL SURGERY, LLC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 777 NORTH ST SUITE 605
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City | PITTSFIELD
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State | MA
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Zip | 01201-4147
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Country | US
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Telephone | 413-447-2859
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Fax | 413-346-6703
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Provider Business Mailing Address
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Address Line | 93 RIDGE AVE
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City | PITTSFIELD
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State | MA
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Zip | 01201-4147
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Country | US
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Telephone | 413-447-2859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCELLA W. BRADWAY
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Credential | M.D.
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Telephone | 413-447-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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