Provider Demographics
NPI:1588772396
Name:BERKSHIRE EAR, NOSE, THROAT AND AUDIOLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BERKSHIRE EAR, NOSE, THROAT AND AUDIOLOGICAL ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LOIODICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:413-448-8291
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4111
Mailing Address - Country:US
Mailing Address - Phone:413-448-8291
Mailing Address - Fax:413-447-9070
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4111
Practice Address - Country:US
Practice Address - Phone:413-448-8291
Practice Address - Fax:413-447-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45563207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724800Medicaid
MAM17998OtherBLUE CROSS OF MA
MAM17998OtherBLUE CROSS OF MA