Provider Demographics
NPI:1528486305
Name:BERRY, JAMES (ATC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 BROWNSON RD
Mailing Address - Street 2:ATHLETIC TRAINING
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-5006
Mailing Address - Country:US
Mailing Address - Phone:410-293-8726
Mailing Address - Fax:
Practice Address - Street 1:566 BROWNSON RD
Practice Address - Street 2:ATHLETIC TRAINING
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-5006
Practice Address - Country:US
Practice Address - Phone:410-293-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00002332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer