Provider Demographics
NPI:1356670632
Name:BERGER, KEVIN MATTHEW (LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:BERGER
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N READING AVE
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512
Mailing Address - Country:US
Mailing Address - Phone:610-367-1633
Mailing Address - Fax:
Practice Address - Street 1:121 N READING AVE
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1011
Practice Address - Country:US
Practice Address - Phone:610-367-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000627208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice