Healthcare Provider Details

I. General information

NPI: 1639148851
Provider Name (Legal Business Name): NATHAN G BERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 33RD ST STE 486
BALTIMORE MD
21218-3322
US

IV. Provider business mailing address

200 E 33RD ST STE 486
BALTIMORE MD
21218-3322
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2683
  • Fax: 410-554-2900
Mailing address:
  • Phone: 410-554-2683
  • Fax: 410-554-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD0023905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: