Provider Demographics
NPI:1275952376
Name:BERGER, KATHERINE BECKETT (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BECKETT
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1201 LAKE JAMES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6780
Mailing Address - Country:US
Mailing Address - Phone:757-523-0022
Mailing Address - Fax:
Practice Address - Street 1:1201 LAKE JAMES DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6780
Practice Address - Country:US
Practice Address - Phone:757-523-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28142208000000X
VA0101261785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB6635710OtherDEA