Healthcare Provider Details

I. General information

NPI: 1275617508
Provider Name (Legal Business Name): MATTHEW A BERGER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MONTAGE MOUNTAIN RD
MOOSIC PA
18507-1782
US

IV. Provider business mailing address

340 MONTAGE MOUNTAIN RD
MOOSIC PA
18507-1782
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-3686
  • Fax:
Mailing address:
  • Phone: 570-346-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD01016L
License Number StatePA

VIII. Authorized Official

Name: DR. MATTHEW A. BERGER
Title or Position: SOLE PRACTITIONER
Credential: MD
Phone: 570-346-3686