Provider Demographics
NPI:1558398248
Name:BERRYMAN, THOMAS JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:BERRYMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PLAZA COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-421-5530
Mailing Address - Fax:570-424-6528
Practice Address - Street 1:400 PLAZA COURT
Practice Address - Street 2:SUITE B
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-421-5530
Practice Address - Fax:570-424-6528
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003710L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPO33366OtherTRICARE
PA6011981OtherAETNA GHI
PA5245200OtherAETNA PPO
PA732465OtherAETNA HMO
PA801461OtherFPH
PA20788OtherGEINSINGER
PABE792609OtherBLUE SHIELD
PA5245200OtherAETNA PPO
U50559Medicare UPIN