Provider Demographics
NPI:1215251590
Name:C. MARKHAM BERRY III, M.D., L.L.C.
Entity type:Organization
Organization Name:C. MARKHAM BERRY III, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:MARKHAM
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-345-2555
Mailing Address - Street 1:154 ROCK BASS CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9321
Mailing Address - Country:US
Mailing Address - Phone:985-845-1622
Mailing Address - Fax:
Practice Address - Street 1:42333 DELUXE PLZ
Practice Address - Street 2:SUITE 7
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1239
Practice Address - Country:US
Practice Address - Phone:985-345-2555
Practice Address - Fax:985-345-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty