Healthcare Provider Details

I. General information

NPI: 1932279718
Provider Name (Legal Business Name): BRUCE JEFFREY BERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOULK RD SUITE A
WILMINGTON DE
19810-3642
US

IV. Provider business mailing address

2000 FOULK RD SUITE A
WILMINGTON DE
19810-3642
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-6555
  • Fax:
Mailing address:
  • Phone: 610-527-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-037544-E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0003974
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD-037544-E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD037544E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: