Healthcare Provider Details

I. General information

NPI: 1184717605
Provider Name (Legal Business Name): RICHARD A. BERG, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 RANDALL PARKWAY
WILMINGTON NC
28403
US

IV. Provider business mailing address

5010 RANDALL PARKWAY
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-5719
  • Fax: 910-799-8180
Mailing address:
  • Phone: 910-791-5719
  • Fax: 910-799-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1976
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1976
License Number StateNC

VIII. Authorized Official

Name: DR. RICHARD A. BERG
Title or Position: NEUROPSYCHOLOGIST/PSYCHOLOGIST
Credential: PH.D.
Phone: 910-791-5719