Basic Information
| Provider Information | |||||||||
| NPI: | 1093798415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKSHIRE PEDIATRIC ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 777 NORTH ST STE 305 | ||||||||
| Address2: | BERKSHIRE PEDIATRIC ASSOCIATES PC | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134998531 | ||||||||
| FaxNumber: | 4134998560 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 NORTH ST STE 305 | ||||||||
| Address2: | BERKSHIRE PEDIATRIC ASSOCIATES PC | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134998531 | ||||||||
| FaxNumber: | 4134998560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROSENFELD | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MD PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4134998534 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | M17595 | 01 | MA | BLUE CROSS GRP | OTHER | 9701290 | 05 | MA | MEDICAID |