MEDICARE: KATHY LINNE VON BERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0054379	MD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1003806449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LINNE VON BERG M.D.

Provider Business Mailing Address
First Line	:	1 E 31ST ST STE N200
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-3902
Country	:	US
Telephone Number	:	410-516-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-2608
Country	:	US
Telephone Number	:	410-516-8270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	12/15/2025

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