Provider Demographics
NPI:1477628527
Name:BERG, COLLEEN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:BERG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:370 FAUNCE CORNER ROAD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1271
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC. 3RD FLOOR
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2097
Practice Address - Country:US
Practice Address - Phone:508-273-4900
Practice Address - Fax:508-273-4901
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA142625363L00000X, 363LP0200X
MARN142625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000876402Medicare PIN
MA000876401Medicare PIN