Provider Demographics
NPI:1306971635
Name:NORTHERN BERKSHIRE FAMILY PRACTICE
Entity type:Organization
Organization Name:NORTHERN BERKSHIRE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-664-4088
Mailing Address - Street 1:820 STATE RD
Mailing Address - Street 2:PO BOX 1067
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3027
Mailing Address - Country:US
Mailing Address - Phone:413-664-4088
Mailing Address - Fax:413-663-6405
Practice Address - Street 1:820 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3027
Practice Address - Country:US
Practice Address - Phone:413-664-4088
Practice Address - Fax:413-663-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784535Medicaid
MAM20573Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER