MEDICARE: DR. RALPH ROGER BERG JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	33613	NC

General Provider Information

NPI Number	:	1154335511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH ROGER BERG JR. M.D.

Provider Business Mailing Address
First Line	:	1503 WAYNE MEMORIAL DR
Second Line	:	SUITE H
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2203
Country	:	US
Telephone Number	:	919-330-4367
Fax Number	:	919-330-4375

Provider Business Practice Location Address
First Line	:	1503 WAYNE MEMORIAL DR
Second Line	:	SUITE H
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2203
Country	:	US
Telephone Number	:	919-330-4367
Fax Number	:	919-330-4375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	05/21/2010

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