MEDICARE: ALALIA BERRY 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	207KI0005X	Clinical & Laboratory Immunology (Allergy & Immunology) Physician	1346566395	UT

General Provider Information

NPI Number	:	1346566395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALALIA BERRY MD

Provider Business Mailing Address
First Line	:	1793 13TH ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-2541
Country	:	US
Telephone Number	:	503-362-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 NW KINGS BLVD STE 100
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97330-4687
Country	:	US
Telephone Number	:	503-362-8385
Fax Number	:	503-362-8435

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	05/18/2022

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Directions to “ ALALIA BERRY MD” Practice Location

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