Provider Demographics
NPI:1659349017
Name:BERG, SAMUEL WILLIAM II (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WILLIAM
Last Name:BERG
Suffix:II
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 1:3130 VICTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-1544
Mailing Address - Country:US
Mailing Address - Phone:757-315-3763
Mailing Address - Fax:757-727-1185
Practice Address - Street 1:3130 VICTORIA BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1544
Practice Address - Country:US
Practice Address - Phone:757-315-3763
Practice Address - Fax:757-727-1185
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975014Medicaid
VA089265OtherANTHEM
VA47211OtherSENTARA HEALTH
VA4975014OtherVIRGINIA PREMIER
VA4975014OtherVIRGINIA PREMIER
VA089265OtherANTHEM
VADN3448Medicare PIN
VA004975014Medicaid
VAP00615303Medicare PIN