Provider Demographics
NPI:1316975139
Name:BERKE, JERRY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HOWARD
Last Name:BERKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2811
Mailing Address - Country:US
Mailing Address - Phone:978-263-3125
Mailing Address - Fax:617-498-2677
Practice Address - Street 1:49 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2811
Practice Address - Country:US
Practice Address - Phone:978-263-3125
Practice Address - Fax:617-498-2677
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34459207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2067617Medicaid
MAB77018Medicare UPIN
MA2067617Medicaid