Organization
CENTRAL BERKSHIRE GASTROENTEROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY J PELLISH M.D. (PRESIDENT)
(413) 499-8590
Entity
Organization
Contact information
Practice address
777 NORTH ST, SUITE 203, PITTSFIELD, MA 01201-4147
(413) 499-8590
(413) 499-6410
Mailing address
777 NORTH ST, SUITE 203, PITTSFIELD, MA 01201-4147
(413) 499-8590
(413) 499-6410
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02102165
—
NY
01
—
687342
TUFTS HEALTHPLAN
MA
01
—
7787
CDPHP
NY
05
—
9701435
—
MA
01
—
M17617
BCBSMA
MA
Enumeration date
01/20/2006
Last updated
04/06/2010
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