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General NPI Number Information
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NPI Number | 1184789893
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Entity Type | Individual
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Provider Name | BERGE MARCARIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 4551 W US HIGHWAY 90 SUITE 101
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City | LAKE CITY
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State | FL
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Zip | 32055-4879
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Country | US
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Telephone | 386-719-9993
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Fax | 386-719-4744
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Provider Business Mailing Address
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Address Line | PO BOX 1359
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City | LAKE CITY
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State | FL
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Zip | 32056-1359
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Country | US
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Telephone | 386-719-9993
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Fax | 386-719-4744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME71870
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | ME71870
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License Number State | FL
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