Organization
THOMAS K BERRY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS K BERRY M.D. (PRESIDENT)
(276) 634-5003
Entity
Organization
Contact information
Practice address
314 FAIRY STREET EXT, SUITE B, MARTINSVILLE, VA 24112-1913
(276) 634-5003
(276) 634-5017
Mailing address
314 FAIRY STREET EXT, SUITE B, MARTINSVILLE, VA 24112-1913
(276) 634-5003
(276) 634-5017
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101042317
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007300018
—
VA
01
—
10381172
CAQH
VA
01
—
216612
ANTHEM
VA
Enumeration date
10/11/2006
Last updated
01/07/2010
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