Provider Demographics
NPI:1609883347
Name:BERGER, BRAD Z (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:Z
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1333
Mailing Address - Country:US
Mailing Address - Phone:228-575-1000
Mailing Address - Fax:228-575-2002
Practice Address - Street 1:11150 HIGHWAY 49N
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503
Practice Address - Country:US
Practice Address - Phone:228-575-1000
Practice Address - Fax:228-575-2002
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS217442084P0804X
FLME1191882084P0804X
OH350686482084P0804X
IL0361498102084P0804X
PAMD4682502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02456089Medicaid
MS02456089Medicaid