Provider Demographics
NPI:1245220847
Name:BERGER, SCOTT R (MD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:R
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:PO BOX 20167
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4096
Mailing Address - Country:US
Mailing Address - Phone:860-208-1797
Mailing Address - Fax:860-931-5035
Practice Address - Street 1:62 JACOBS HILL RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1650
Practice Address - Country:US
Practice Address - Phone:860-208-1879
Practice Address - Fax:860-931-5035
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010027000CT01OtherBLUE SHIELD OF CT
CT001270008Medicaid
CT010027000CT01OtherBLUE SHIELD OF CT
CT110001241Medicare PIN