Provider Demographics
NPI:1326036351
Name:BERJE, ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:BERJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALBERTO
Other - Middle Name:JULIO
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:2901 67TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5520
Mailing Address - Country:US
Mailing Address - Phone:727-289-9530
Mailing Address - Fax:
Practice Address - Street 1:2901 67TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-5520
Practice Address - Country:US
Practice Address - Phone:727-289-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME167652085R0202X
FLME 16765208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372472700Medicaid
FL78204Medicare ID - Type UnspecifiedMEDICARE #
FL372472700Medicaid
FLD70702Medicare UPIN
FL78204UMedicare PIN