Provider Demographics
NPI:1275060998
Name:BERGER, TRAVIS (DO)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S FORGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-9513
Mailing Address - Country:US
Mailing Address - Phone:717-838-1301
Mailing Address - Fax:717-838-5811
Practice Address - Street 1:1400 S FORGE RD STE 1
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-9513
Practice Address - Country:US
Practice Address - Phone:717-838-1301
Practice Address - Fax:717-838-5811
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017689207Q00000X
390200000X
PAOS020465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program