MEDICARE: BERKELEY FAMILY MEDICINE

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	011191	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	C10269	OTHER	WV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6784310001	OTHER	WV	DMEPOS PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609974229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	101 MARCLEY DR
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-2977
Country	:	US
Telephone Number	:	304-263-8911
Fax Number	:	304-263-9450

Provider Business Practice Location Address
First Line	:	101 MARCLEY DR
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-2977
Country	:	US
Telephone Number	:	304-263-8911
Fax Number	:	304-263-9450

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. ANGELA L BARBER
Credential	:
Telephone Number	:	304-263-8911

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/10/2015

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25401-2977

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1942290317 — PAMELA J GAVIN NP
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1366482010 — MR. HARVEY D REISENWEBER M.D.
Practice Location Address:

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1427092956 — MR. SAMUEL DAVID MORRIS M.D.
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25401-2977

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1114021987 — BIO-MEDICAL APPLICATIONS OF WEST VIRGINIA, INC.
Practice Location Address:

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Directions to “BERKELEY FAMILY MEDICINE ” Practice Location

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