Healthcare Provider Details

I. General information

NPI: 1548554678
Provider Name (Legal Business Name): JULIE SUZANNE BERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 PROSPERITY DR STE 150
SILVER SPRING MD
20904-1687
US

IV. Provider business mailing address

950 N GLEBE RD STE 700
ARLINGTON VA
22203-4173
US

V. Phone/Fax

Practice location:
  • Phone: 301-989-0085
  • Fax:
Mailing address:
  • Phone: 571-982-6636
  • Fax: 240-696-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0086444
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD042023
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: