Provider Demographics
NPI:1164448429
Name:BERGER, TODD J (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:J
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 1:6300 LA CALMA DR
Mailing Address - Street 2:EMERGENCY SERVICE PARTNERS
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3843
Mailing Address - Country:US
Mailing Address - Phone:512-452-8533
Mailing Address - Fax:
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48597207P00000X
TXN9512207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine