Provider Demographics
NPI:1790062347
Name:NATHAN G. BERGER, M.D.,P.A.
Entity Type:Organization
Organization Name:NATHAN G. BERGER, M.D.,P.A.
Other - Org Name:NATHAN G. BERGER, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATAHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-554-2683
Mailing Address - Street 1:200 E 33RD ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3322
Mailing Address - Country:US
Mailing Address - Phone:410-554-2683
Mailing Address - Fax:410-554-2900
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:SUITE 470
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-554-2683
Practice Address - Fax:410-554-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23905207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015590OtherEHP
MD160006507Medicaid
MD39966805-1722OtherBCBS
MD160006507Medicaid