Individual
MR. TOMMIE RUSSELL BERRY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3646
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3646
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
35.137255
OH
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD486652
PA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
35.137255
OH
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
85696
SC
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
89500
GA
Other
Enumeration date
03/31/2014
Last updated
08/28/2024
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