MEDICARE: DR. PETER DAVID BERG 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	207W00000X	Ophthalmology Physician	154150	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1780621730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER DAVID BERG M.D.

Provider Business Mailing Address
First Line	:	11 PLAZA ST W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3706
Country	:	US
Telephone Number	:	718-638-2020
Fax Number	:	718-230-3429

Provider Business Practice Location Address
First Line	:	11 PLAZA ST W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3706
Country	:	US
Telephone Number	:	718-638-2020
Fax Number	:	718-230-3429

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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