=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205098548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARD THOMAS BERRY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2008
-----------------------------------------------------
Last Update Date | 09/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 TOWNSHIP LINE RD STE 150
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-860-3360
-----------------------------------------------------
Fax | 215-860-3362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 TOWNSHIP LINE RD STE 150
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-860-3360
-----------------------------------------------------
Fax | 215-860-3362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | 25MA11416000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number | MD452348
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------