Healthcare Provider Details

I. General information

NPI: 1376602391
Provider Name (Legal Business Name): DEBORAH B BERG RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 BUSH ST
RALEIGH NC
27609-7511
US

IV. Provider business mailing address

1025 CEDARHURST DR
RALEIGH NC
27609-5415
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-7807
  • Fax: 919-876-8823
Mailing address:
  • Phone: 919-878-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberL001653
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: