MEDICARE: CARLY BERG 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	208000000X	Pediatrics Physician	MD70007528	WA
2	208000000X	Pediatrics Physician	2014020062	MO

General Provider Information

NPI Number	:	1336554658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY BERG MD

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 WESLEY ST
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1613
Country	:	US
Telephone Number	:	360-435-6525
Fax Number	:	360-435-2634

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	01/16/2026

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Directions to “ CARLY BERG MD” Practice Location

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