Provider Demographics
NPI:1871569517
Name:BERKLEY, ELIZA (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-573-6033
Mailing Address - Fax:757-624-2254
Practice Address - Street 1:6433 ELEANOR CT
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1009
Practice Address - Country:US
Practice Address - Phone:704-685-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20050184207VX0000X
VA0101241848207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
10265084OtherOPTIMA/SENTARA
VA303352OtherANTHEM FF
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCIGNA
VA303361OtherANTHEM FC
1871569517OtherUNITED HEALTHCARE
NC5907694Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
NC07694OtherNC BC/BS
1871569517OtherTRICARE EAST
VA303374OtherANTHEM JCM
VA1871569517Medicaid
VAPAROtherCORVEL/CORCARE
VA303377OtherANTHEM COLLEY
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherAETNA
VAPAROtherVIRGINIA PREMIER HEALTH