Provider Demographics
NPI:1497841159
Name:BERG, MONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 FRANKLIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-872-2220
Mailing Address - Fax:508-872-2270
Practice Address - Street 1:475 FRANKLIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-872-2220
Practice Address - Fax:508-872-2270
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35755207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4105OtherHARVARD PILGRIM
B18195OtherBLUE SHIELD
711353OtherTUFTS
B87071Medicare UPIN
B18195Medicare ID - Type Unspecified