Provider Demographics
NPI:1851339725
Name:BERGER, PHILIP D (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7099
Mailing Address - Country:US
Mailing Address - Phone:614-855-4878
Mailing Address - Fax:614-855-4813
Practice Address - Street 1:55 N HIGH ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7099
Practice Address - Country:US
Practice Address - Phone:614-627-1878
Practice Address - Fax:614-855-4813
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00117645OtherRAILROAD MEDICARE PIN
OH2152218Medicaid
OH7321781Medicare PIN
OHG77313Medicare UPIN