Healthcare Provider Details

I. General information

NPI: 1730685637
Provider Name (Legal Business Name): ALEXANDER OLIVER BERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
PORTSMOUTH VA
23708
US

IV. Provider business mailing address

NMRTC PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
PORTSMOUTH VA
23708
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7762
  • Fax:
Mailing address:
  • Phone: 904-542-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101267597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: