Provider Demographics
NPI:1043475932
Name:BERKSHIRE COLON & RECTAL SURGERY, LLC
Entity type:Organization
Organization Name:BERKSHIRE COLON & RECTAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-447-2859
Mailing Address - Street 1:93 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4147
Mailing Address - Country:US
Mailing Address - Phone:413-447-2859
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 605
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-447-2859
Practice Address - Fax:413-346-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD04850OtherRAILROAD MEDICARE