Provider Demographics
NPI:1265669618
Name:BERG, MATTHEW ERIC (MSOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ERIC
Last Name:BERG
Suffix:
Gender:M
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BALDWIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9005
Mailing Address - Country:US
Mailing Address - Phone:413-854-7880
Mailing Address - Fax:
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1608
Practice Address - Country:US
Practice Address - Phone:413-854-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist