MEDICARE: KEITH EDWARD BERGER MD

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	207RG0100X	Gastroenterology Physician	0101032987	VA

General Provider Information

NPI Number	:	1225012966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH EDWARD BERGER MD

Provider Business Mailing Address
First Line	:	1301 FIRST COLONIAL RD
Second Line	:	STE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454
Country	:	US
Telephone Number	:	757-412-4919
Fax Number	:	757-412-4898

Provider Business Practice Location Address
First Line	:	1301 FIRST COLONIAL RD
Second Line	:	STE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2263
Country	:	US
Telephone Number	:	757-412-4919
Fax Number	:	757-412-4898

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	02/10/2025

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