Provider Demographics
NPI:1932113164
Name:BERGER, DAIVD TOBIAS
Entity Type:Individual
Prefix:
First Name:DAIVD
Middle Name:TOBIAS
Last Name:BERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 PLEASANT STREET
Practice Address - Street 2:CENTER FOR INTEGRATIVE MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-228-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH328101YM0800X
CA39176106H00000X
NH2170225100000X
CA10510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011572Medicaid
14Y004863NH01OtherMENTAL HEALTH COUNSELOR
6175598OtherPHYSICAL THERAPY
NH0805192Y0NH01OtherPHYSICAL THERAPY
2194835OtherMENTAL HEALTH COUNSELOR
NH30011572Medicaid
6175598OtherPHYSICAL THERAPY