Provider Demographics
NPI:1467595207
Name:BERGER, ANDREW C
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
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 1:20 PANAEWA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3833
Mailing Address - Country:US
Mailing Address - Phone:808-974-4300
Mailing Address - Fax:808-974-4310
Practice Address - Street 1:37 KEKAULIKE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2462
Practice Address - Country:US
Practice Address - Phone:808-974-4300
Practice Address - Fax:808-974-4310
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539372-15Medicaid