Provider Demographics
NPI:1417066465
Name:BERGER, JEROME A
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:A
Last Name:BERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 OXEYE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1019
Mailing Address - Country:US
Mailing Address - Phone:410-484-2884
Mailing Address - Fax:410-484-6952
Practice Address - Street 1:7900 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5816
Practice Address - Country:US
Practice Address - Phone:410-665-8000
Practice Address - Fax:410-665-6451
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist