MEDICARE: WESTERN BERKS MEDICAL ASSOCIATES

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	113042	OTHER	PA	B/S BERARD N. AVELLA, MD
2	631777	OTHER	PA	B/S WESTERN BERKS MED
3	01571701	OTHER	PA	B/C BERARD N. AVELLA, MD
4	02520600	OTHER	PA	B/C WESTERN BERKS MED
5	1265439798	OTHER	PA	NPI FOR BERARD AVELLA, MD

General Provider Information

NPI Number	:	1487671145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN BERKS MEDICAL ASSOCIATES

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	:	PRESIDENT
Name	:	DR. BERARD NICHOLAS AVELLA
Credential	:	MD
Telephone Number	:	610-678-8800

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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