Provider Demographics
NPI:1043328446
Name:BERGER, STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
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 1:12170 BEAR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4970
Mailing Address - Country:US
Mailing Address - Phone:561-571-1177
Mailing Address - Fax:561-200-0478
Practice Address - Street 1:12170 BEAR RIVER RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4970
Practice Address - Country:US
Practice Address - Phone:561-571-1177
Practice Address - Fax:561-200-0478
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145164207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
53A741Medicare UPIN
B16079Medicare ID - Type Unspecified