MEDICARE: DR. SAMUEL WILLIAM BERG II 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	207R00000X	Internal Medicine Physician	0101054512	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	089265	OTHER	VA	ANTHEM
3	47211	OTHER	VA	SENTARA HEALTH
4	4975014	OTHER	VA	VIRGINIA PREMIER

General Provider Information

NPI Number	:	1659349017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL WILLIAM BERG II M.D.

Provider Business Mailing Address
First Line	:	3130 VICTORIA BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-1544
Country	:	US
Telephone Number	:	757-315-3763
Fax Number	:	757-727-1185

Provider Business Practice Location Address
First Line	:	3130 VICTORIA BLVD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23661-1544
Country	:	US
Telephone Number	:	757-315-3763
Fax Number	:	757-727-1185

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/19/2008

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