Provider Demographics
NPI:1740220953
Name:BERG, KARIN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:DIANE
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-5183
Mailing Address - Country:US
Mailing Address - Phone:901-526-7444
Mailing Address - Fax:901-473-0660
Practice Address - Street 1:3495 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8803
Practice Address - Country:US
Practice Address - Phone:901-526-7444
Practice Address - Fax:901-473-0660
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0055186207ZP0101X
TN41206207ZP0101X
WYTL2359207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31921Medicare UPIN