Provider Demographics
NPI:1710364195
Name:BERGER, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
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:PO BOX 6956
Mailing Address - Street 2:BLDG 2 SUITE 100
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866-6956
Mailing Address - Country:US
Mailing Address - Phone:719-687-3330
Mailing Address - Fax:
Practice Address - Street 1:750 E US HIGHWAY 24
Practice Address - Street 2:BLDG 2 SUITE 100
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7750
Practice Address - Country:US
Practice Address - Phone:719-687-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10623820819Medicaid