Provider Demographics
NPI:1689714040
Name:BERKSHIRE OSTEOPATHIC HEALTH, LLC
Entity type:Organization
Organization Name:BERKSHIRE OSTEOPATHIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA AND OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:413-442-0085
Mailing Address - Street 1:42 SUMMER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4624
Mailing Address - Country:US
Mailing Address - Phone:413-442-0085
Mailing Address - Fax:413-464-9143
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4624
Practice Address - Country:US
Practice Address - Phone:413-442-0085
Practice Address - Fax:413-464-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233633204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19088OtherBCBS ID
MA9768190Medicaid
MA9768190Medicaid