Provider Demographics
NPI:1053632273
Name:BERGER, JENNIFER HAAGA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HAAGA
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:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-432-1591
Mailing Address - Fax:901-432-1596
Practice Address - Street 1:1255 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2227
Practice Address - Country:US
Practice Address - Phone:901-432-1591
Practice Address - Fax:901-432-1596
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05553876Medicaid
TN6026509OtherBCBS TN
TNQ001465Medicaid
AR199971001Medicaid