Healthcare Provider Details

I. General information

NPI: 1790062347
Provider Name (Legal Business Name): NATHAN G. BERGER, M.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 33RD ST SUITE 470
BALTIMORE MD
21218-3322
US

IV. Provider business mailing address

200 E 33RD ST SUITE 470
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 Code207VG0400X
TaxonomyGynecology Physician
License NumberD23905
License Number StateMD

VIII. Authorized Official

Name: NATAHN G BERGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-554-2683