MEDICARE: KRISTEN A. BERRY DO

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	207Q00000X	Family Medicine Physician	OS012123	PA

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	:	1528069200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN A. BERRY DO

Provider Business Mailing Address
First Line	:	4148 LANCASTER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1727
Country	:	US
Telephone Number	:	215-662-0119
Fax Number	:	215-662-5339

Provider Business Practice Location Address
First Line	:	4148 LANCASTER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1727
Country	:	US
Telephone Number	:	215-662-0119
Fax Number	:	215-662-5339

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	01/26/2016

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