Provider Demographics
NPI:1235178955
Name:BERGER, JEFFREY J (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-481-4424
Mailing Address - Fax:757-481-3820
Practice Address - Street 1:1120 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2418
Practice Address - Country:US
Practice Address - Phone:757-481-4424
Practice Address - Fax:757-481-3820
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007301871Medicaid
053028OtherANTHEM
212580OtherCIGNA
5784156OtherGHI
4498701OtherAETNA
1700213OtherUNITED HEALTHCARE
221909OtherMAMSI
35054OtherOPTIMA HEALTH PLAN
NC890512LMedicaid
020022377OtherRAILROAD MEDICARE
020022377OtherRAILROAD MEDICARE
VA007301871Medicaid