Provider Demographics
NPI:1215150990
Name:BERRY, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAN MAR DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2271
Mailing Address - Country:US
Mailing Address - Phone:508-699-9417
Mailing Address - Fax:508-699-2127
Practice Address - Street 1:30 MAN MAR DR
Practice Address - Street 2:SUITE 7
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2271
Practice Address - Country:US
Practice Address - Phone:508-699-9417
Practice Address - Fax:508-699-2127
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA715622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA737405OtherTUFTS
MA003361OtherHARVARD PILGRIM HEALTH CA
MAJ08716OtherBCBSMA
MA003361OtherHARVARD PILGRIM HEALTH CA
E11142Medicare UPIN