Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 225054 | MA |
N | 208800000X | Urologist | TL35339 | SC |
NPI | 1013019439 |
---|---|
Provider Name | Alexander M Berry |
First Address | Springfield, MA 01107 |
Second Address | Springfield, MA 01107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 09/03/2016 |