Healthcare Provider Details

I. General information

NPI: 1346280963
Provider Name (Legal Business Name): KATHRYN W BERGER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SPORTS MEDICINE DRIVE, STE 101
FISHERSVILLE VA
22939
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-2537
  • Fax: 540-213-2522
Mailing address:
  • Phone: 409-325-1685
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD01365
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number660225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: