Provider Demographics
NPI:1609192988
Name:BERGER, AGATHA
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT STREET
Mailing Address - Street 2:MEZZANINE
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-2313
Mailing Address - Fax:
Practice Address - Street 1:833 CHESTNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4404
Practice Address - Country:US
Practice Address - Phone:215-955-5000
Practice Address - Fax:302-733-3340
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0012111207V00000X
PAMD451857207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology