Provider Demographics
NPI:1003819749
Name:DADOURIAN, BERGE JACK (MD)
Entity Type:Individual
Prefix:
First Name:BERGE
Middle Name:JACK
Last Name:DADOURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S RAMPART BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5721
Mailing Address - Country:US
Mailing Address - Phone:702-906-1100
Mailing Address - Fax:702-906-1110
Practice Address - Street 1:400 S RAMPART BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5721
Practice Address - Country:US
Practice Address - Phone:702-906-1100
Practice Address - Fax:702-906-1110
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5819207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA93002Medicare UPIN
NV06WCGXW01Medicare PIN
NV06WCGXW01Medicare PIN