Provider Demographics
NPI:1962491449
Name:BERGER, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22 WATWERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118
Mailing Address - Country:US
Mailing Address - Phone:215-275-8597
Mailing Address - Fax:
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-5064
Practice Address - Fax:215-829-6301
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD032563E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE71362Medicare UPIN