Provider Demographics
NPI:1730139155
Name:BERGER, ERICA L (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:BERGER
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2312
Mailing Address - Fax:704-384-2316
Practice Address - Street 1:8110 HEALTHCARE LOOP
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7069
Practice Address - Country:US
Practice Address - Phone:704-384-2312
Practice Address - Fax:704-384-2316
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34504300Medicaid
NC5907923Medicaid
WI60276OtherDEAN HEALTH INSURANCE
WI3916284913AOtherJOHN DEERE
SCN01365Medicaid
SCN01365Medicaid
WI60276OtherDEAN HEALTH INSURANCE
NC5907923Medicaid