Basic Information
Provider Information | |||||||||
NPI: | 1881761245 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BERKEY | ||||||||
FirstName: | PETER | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4440 FRUITVILLE RD | ||||||||
Address2: |   | ||||||||
City: | SARASOTA | ||||||||
State: | FL | ||||||||
PostalCode: | 342321926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9413660134 | ||||||||
FaxNumber: | 9414041760 | ||||||||
Practice Location | |||||||||
Address1: | 3251 3RD AVE N RM 125 | ||||||||
Address2: |   | ||||||||
City: | ST PETERSBURG | ||||||||
State: | FL | ||||||||
PostalCode: | 337138549 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7274984969 | ||||||||
FaxNumber: | 8558965258 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2006 | ||||||||
LastUpdateDate: | 06/24/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 149037 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RI0200X | 149037 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | ME132416 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
ID | Type | State | Issuer | Description | 0000924 | 01 |   | GHI | OTHER | 3401982 | 01 |   | UNITED HEALTHCARE | OTHER | WS365 | 01 |   | OXFORD | OTHER | 01091143 | 05 | NY |   | MEDICAID | 0915351 | 01 |   | AETNA AND US HEALTHCARE | OTHER | 09727P | 01 |   | HIP | OTHER | 0D1595 | 01 |   | HEALTHNET | OTHER | 440003595 | 01 |   | RR MEDICARE | OTHER |