Basic Information
| Provider Information | |||||||||
| NPI: | 1538270061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERKSHIRE UROLOGICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1077 | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012021077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134998575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 777 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012014147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134998575 | ||||||||
| FaxNumber: | 4134996409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SILVERSTEIN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4134998575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 14968 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 9700391 | 05 | MA | MEDICAID | M17507 | 01 | MA | BLUE SHIELD | OTHER |