Provider Demographics
NPI:1225470594
Name:BERGER, WADE D (DO)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:D
Last Name:BERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:93 BOUNDRY LANE
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009
Mailing Address - Country:US
Mailing Address - Phone:724-773-6400
Mailing Address - Fax:724-770-7934
Practice Address - Street 1:93 BOUNDRY LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2949
Practice Address - Country:US
Practice Address - Phone:724-773-6400
Practice Address - Fax:724-770-7934
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014858208600000X
PAOS018895208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery