Provider Demographics
NPI:1407888746
Name:BERGER, ERIC HOADLEY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:HOADLEY
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1029
Mailing Address - Country:US
Mailing Address - Phone:203-776-2906
Mailing Address - Fax:
Practice Address - Street 1:58 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1029
Practice Address - Country:US
Practice Address - Phone:203-776-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0163422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001163427Medicaid
B39320Medicare UPIN
CT001163427Medicaid