Provider Demographics
NPI:1194077909
Name:ROSE ANN BERWALD, M.D.
Entity type:Organization
Organization Name:ROSE ANN BERWALD, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROSE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-344-7673
Mailing Address - Street 1:966 PARK ST STE B2
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-344-7673
Mailing Address - Fax:781-344-5955
Practice Address - Street 1:966 PARK ST STE B2
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-344-7673
Practice Address - Fax:781-344-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70519207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070519OtherTUFTS
MA32136OtherAETNA/US HEALTCARE
MAB21216OtherCIGNA
MA110047284/AMedicaid
MA13564OtherHARVARD PILGRIM HEALTHCARE
MAJ08817OtherBLUE CROSS BLUE SHIELD
MA3065320OtherNEIGHBORHOOD HEALTH PLAN
MA3065320OtherNEIGHBORHOOD HEALTH PLAN
MA32136OtherAETNA/US HEALTCARE