Provider Demographics
NPI:1528078193
Name:BERRY, LYN E (MD)
Entity type:Individual
Prefix:
First Name:LYN
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 E 31ST STREET
Mailing Address - Street 2:OAKCARE MEDICAL GROUP
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1080
Mailing Address - Country:US
Mailing Address - Phone:510-437-4323
Mailing Address - Fax:510-437-5042
Practice Address - Street 1:1411 E 31ST STREET
Practice Address - Street 2:OAKCARE MEDICAL GROUP
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1080
Practice Address - Country:US
Practice Address - Phone:510-437-4323
Practice Address - Fax:510-437-5042
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506780Medicaid
CA00G506780Medicaid
CA00G506780Medicare ID - Type Unspecified