Individual
MR. GREG BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO CPED
Contact information
Practice address
1102 BROWN ST, WASHINGTON, NC 27889
(252) 940-1203
(252) 940-1206
Mailing address
106 MEDICAL DRIVE, PO BOX 1471, ELIZ CITY, NC 27909
(252) 338-3002
(252) 338-2902
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO1835
—
224P00000X
Prosthetist
CPO1835
—
332BC3200X
Customized Equipment (DME)
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0482P
BCBS
NC
01
—
384410
BCBS
VA
05
—
7701327
—
NC
01
—
7795163
INDIVID EDS PED ORTHO
—
01
—
7795164
INDIVID EDS PED PROSTH
—
05
—
9190511
—
VA
Enumeration date
04/05/2006
Last updated
09/30/2013
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