Provider Demographics
NPI:1750358685
Name:BERRY, ALLEN D III (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:D
Last Name:BERRY
Suffix:III
Gender:M
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 1483
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1483
Mailing Address - Country:US
Mailing Address - Phone:877-262-6446
Mailing Address - Fax:
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-765-2131
Practice Address - Fax:901-765-2064
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15224207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117237001Medicaid
TN3046982Medicaid
AR5M819C278Medicare PIN
TN3046981Medicare PIN
AR117237001Medicaid