Healthcare Provider Details

I. General information

NPI: 1164545901
Provider Name (Legal Business Name): CHARLES J. BERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SAINT GERMAIN AVE
SAN FRANCISCO CA
94114-2131
US

IV. Provider business mailing address

195 SAINT GERMAIN AVE
SAN FRANCISCO CA
94114-2131
US

V. Phone/Fax

Practice location:
  • Phone: 415-681-1174
  • Fax:
Mailing address:
  • Phone: 415-681-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA22346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: