MEDICARE: DR. BERARD NICHOLAS AVELLA 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	MD010911E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02520600	OTHER	PA	B/C WESTERN BERKS MEDIC
2	96467	OTHER	PA	HEALTHAMERICA ID #
3	01571701	OTHER	PA	BLUE CROSS ID #
4	631777	OTHER	PA	B/S WESTERN BERKS MEDIC
5	113042	OTHER	PA	BLUE SHIELD ID #

General Provider Information

NPI Number	:	1265439798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERARD NICHOLAS AVELLA MD

Provider Business Mailing Address
First Line	:	2913 WINDMILL RD STE 7
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1680
Country	:	US
Telephone Number	:	610-678-8800
Fax Number	:	610-678-8286

Provider Business Practice Location Address
First Line	:	2913 WINDMILL RD STE 7
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-1680
Country	:	US
Telephone Number	:	610-678-8800
Fax Number	:	610-678-8286

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/09/2007

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