MEDICARE: DR. FRED KEITH BERGER 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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	G33996	CA

General Provider Information

NPI Number	:	1508890021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED KEITH BERGER M.D.

Provider Business Mailing Address
First Line	:	5317 CALLE VIS
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1920
Country	:	US
Telephone Number	:	619-298-3251
Fax Number	:	858-488-8839

Provider Business Practice Location Address
First Line	:	5317 CALLE VIS
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1920
Country	:	US
Telephone Number	:	619-298-3251
Fax Number	:	858-488-8839

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/09/2021

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