Provider Demographics
NPI:1003852385
Name:BERGER, BRIAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:BERGER
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 1:4 PALISADES DR
Mailing Address - Street 2:STE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1443
Mailing Address - Country:US
Mailing Address - Phone:785-488-8016
Mailing Address - Fax:
Practice Address - Street 1:730 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8778
Practice Address - Country:US
Practice Address - Phone:316-283-1141
Practice Address - Fax:316-283-1162
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-370082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147144303Medicaid
TX147144304Medicaid
KS201095280BMedicaid
TX8P8210OtherBCBS
KS201095280AMedicaid
KS016701015Medicare UPIN
KSKA3434008Medicare UPIN
TX8P8210OtherBCBS