Healthcare Provider Details

I. General information

NPI: 1861596058
Provider Name (Legal Business Name): MARC STUART BERGER M.D.,C.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W CYPRESS ST STE 690
TAMPA FL
33607-4112
US

IV. Provider business mailing address

360 10TH AVE S
SAFETY HARBOR FL
34695-3816
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-2200
  • Fax:
Mailing address:
  • Phone: 727-600-9205
  • Fax: 614-386-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66567
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME-81929
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number66567
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberFTP 45348
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberR0996
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME81929
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME-81929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: