Provider Demographics
NPI:1225014194
Name:BERGER, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BICENTENNIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1900
Mailing Address - Country:US
Mailing Address - Phone:413-783-3100
Mailing Address - Fax:413-782-7998
Practice Address - Street 1:275 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1900
Practice Address - Country:US
Practice Address - Phone:413-783-3100
Practice Address - Fax:413-782-7998
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33015207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN51536OtherBLUE SHIELD
MA033015OtherTUFTS
117561OtherFALLON COMM. HEALTH PLAN
4215989OtherAETNA
MA150658OtherHARVARD/PILGRIM
123633OtherU.S. HEALTH CARE
MA748930OtherCONNECTICARE
MA10548OtherHEALTH NEW ENGLAND
40047OtherDAVIS VISION
MAN51536OtherBLUE SHIELD
MA748930OtherCONNECTICARE
1225014194Medicare PIN