Provider Demographics
NPI:1992784573
Name:CATHY J. BERRY, M.D., P.C.
Entity type:Organization
Organization Name:CATHY J. BERRY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-8105
Mailing Address - Street 1:101 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1149
Mailing Address - Country:US
Mailing Address - Phone:315-422-8105
Mailing Address - Fax:315-471-9903
Practice Address - Street 1:101 PINE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1149
Practice Address - Country:US
Practice Address - Phone:315-422-8105
Practice Address - Fax:315-471-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618142Medicaid
NYBA0731Medicare PIN
NYY47192Medicare UPIN
NY02618142Medicaid