Provider Demographics
NPI:1033130505
Name:BERGER, ERIC E (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:E
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DUDLEY ST.
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-453-4500
Mailing Address - Fax:401-444-3329
Practice Address - Street 1:2 DUDLEY ST.
Practice Address - Street 2:SUITE 360
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-453-4500
Practice Address - Fax:401-444-3329
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06783207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003694Medicaid
RIC90347Medicare UPIN
RI709003694Medicare ID - Type Unspecified