Provider Demographics
NPI:1689643884
Name:BERG, ROBERTA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:L
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:144 STONY POINT ROAD
Mailing Address - Street 2:SONOMA COUNTY INDIAN HEALTH PROJECT
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401
Mailing Address - Country:US
Mailing Address - Phone:707-521-4500
Mailing Address - Fax:707-544-4626
Practice Address - Street 1:144 STONY POINT ROAD
Practice Address - Street 2:SONOMA COUNTY INDIAN HEALTH PROJECT
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-521-4500
Practice Address - Fax:707-544-4626
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG18770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G187700Medicaid
00G187702Medicare PIN
CA00G187700Medicaid