MEDICARE: DR. JOHN F BERRY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	039341	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013967058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN F BERRY JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 666
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632-0666
Country	:	US
Telephone Number	:	508-775-3177
Fax Number	:	508-775-0895

Provider Business Practice Location Address
First Line	:	1949 ROUTE 28
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632-3119
Country	:	US
Telephone Number	:	508-775-3177
Fax Number	:	508-775-0895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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