Individual
THOMAS K BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PC
Contact information
Practice address
314 FAIRY STREET EXT, STE B, MARTINSVILLE, VA 24112-1913
(276) 634-5003
(276) 634-5017
Mailing address
314 FAIRY STREET EXT, STE B, MARTINSVILLE, VA 24112-1913
(276) 634-5003
(276) 634-5017
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101042317
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10381172
CAQH
VA
01
—
216612
ANTHEM
—
01
—
5297564
AETNA
VA
05
—
7300018
—
VA
01
—
C08438
MEDICARE PIN
VA
Enumeration date
10/11/2005
Last updated
12/11/2007
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