Provider Demographics
NPI:1205836418
Name:BERGER, TODD A (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5800 49TH ST N
Mailing Address - Street 2:S-109
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2146
Mailing Address - Country:US
Mailing Address - Phone:727-522-1115
Mailing Address - Fax:727-522-0018
Practice Address - Street 1:5800 49TH ST N
Practice Address - Street 2:S-109
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2146
Practice Address - Country:US
Practice Address - Phone:727-522-1115
Practice Address - Fax:727-522-0018
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0058512207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377279900Medicaid
FL23381ZMedicare PIN
FL23381Medicare PIN
FLF22807Medicare UPIN
FL377279900Medicaid
FL23381VMedicare PIN