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NPI Code Detail

MEDICARE: DR. FANNY J BERG MD

MEDICARE: DR. FANNY J 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
1174400000XSpecialistC1-0002879DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720182256
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FANNY J BERG MD
Provider Business Mailing Address
First Line : 2000 FOULK RD
Second Line : SUITE A
City : WILMINGTON
State : DE
Zip : 19810-3642
Country : US
Telephone Number : 302-475-8000
Fax Number : 302-475-8043
Provider Business Practice Location Address
First Line : 2000 FOULK RD
Second Line : SUITE A
City : WILMINGTON
State : DE
Zip : 19810-3642
Country : US
Telephone Number : 302-475-8000
Fax Number : 302-475-8043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/15/2015

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