Provider Demographics
NPI:1558324657
Name:BERGER, BRUCE W (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 CROSSROADS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5421
Mailing Address - Country:US
Mailing Address - Phone:410-581-1600
Mailing Address - Fax:410-581-1603
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 460
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-581-1600
Practice Address - Fax:410-581-1603
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-22
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Provider Licenses
StateLicense IDTaxonomies
MDD13959208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118781300Medicaid
D77949Medicare UPIN
MD731L580DMedicare PIN