Provider Demographics
NPI:1225012966
Name:BERGER, KEITH EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:EDWARD
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 1:1301 FIRST COLONIAL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-412-4919
Mailing Address - Fax:757-412-4898
Practice Address - Street 1:1301 FIRST COLONIAL RD
Practice Address - Street 2:STE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2263
Practice Address - Country:US
Practice Address - Phone:757-412-4919
Practice Address - Fax:757-412-4898
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032987207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07404Medicare UPIN
VA100000277Medicare ID - Type Unspecified