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NPI Code Detail

MEDICARE: EGERTON K VAN DEN BERG JR. M.D.

MEDICARE: EGERTON K VAN DEN BERG JR. 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
1207R00000XInternal Medicine Physician117611TX
2207RI0011XInterventional Cardiology Physician117611VA
3207RC0000XCardiovascular Disease PhysicianME54054FL

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 : 1821192501
Entity Type Code : Individual
Provider Name (Legal Business Name) : EGERTON K VAN DEN BERG JR. M.D.
Provider Business Mailing Address
First Line : 2320 N ORANGE AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5506
Country : US
Telephone Number : 407-896-0054
Fax Number : 407-898-4463
Provider Business Practice Location Address
First Line : 2320 N ORANGE AVE
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5506
Country : US
Telephone Number : 407-896-0054
Fax Number : 407-898-4463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 09/12/2019

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