Provider Demographics
NPI:1073577243
Name:BERGER, MALCOLM P (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:P
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 1:985 PENN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRACKENRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15014-1160
Mailing Address - Country:US
Mailing Address - Phone:724-224-2083
Mailing Address - Fax:724-224-2860
Practice Address - Street 1:985 PENN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BRACKENRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15014-1160
Practice Address - Country:US
Practice Address - Phone:724-224-2083
Practice Address - Fax:724-224-2860
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017633E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007276750002Medicaid
PA0007276750002Medicaid
PA146405Medicare ID - Type Unspecified