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NPI Code Detail

MEDICARE: DR. DAVID S BERG PH.D.

MEDICARE: DR. DAVID S BERG PH.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
1103TC0700XClinical PsychologistPS002938-LPA

General Provider Information

NPI Number : 1578534681
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID S BERG PH.D.
Provider Business Mailing Address
First Line : 40 WOODALE RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3430
Country : US
Telephone Number : 215-790-9005
Fax Number :
Provider Business Practice Location Address
First Line : 40 WOODALE RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-3430
Country : US
Telephone Number : 215-790-9005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 07/22/2010

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