Healthcare Provider Details

I. General information

NPI: 1003806449
Provider Name (Legal Business Name): KATHY LINNE VON BERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 N CHARLES ST
BALTIMORE MD
21218-2608
US

IV. Provider business mailing address

1 E 31ST ST STE N200
BALTIMORE MD
21218-3902
US

V. Phone/Fax

Practice location:
  • Phone: 410-516-8270
  • Fax:
Mailing address:
  • Phone: 410-516-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0054379
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: