Healthcare Provider Details

I. General information

NPI: 1811944853
Provider Name (Legal Business Name): LAUREL R BERGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

500 NE MULTNOMAH ST FL 11
PORTLAND OR
97232-2023
US

V. Phone/Fax

Practice location:
  • Phone: 503-240-4053
  • Fax:
Mailing address:
  • Phone: 503-240-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD150390
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2003-0077
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: