Healthcare Provider Details

I. General information

NPI: 1023125911
Provider Name (Legal Business Name): ROBERT MICHAEL BERG PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENUE D BLD 361
PERRY POINT MD
21902-1015
US

IV. Provider business mailing address

8 VALLEY FORGE PL
NORTH EAST MD
21901-4612
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1122
Mailing address:
  • Phone: 410-287-2691
  • Fax: 410-642-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number08264
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: