Provider Demographics
NPI:1295718237
Name:BERGER, MATTHEW ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
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 1:340 MONTAGE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1782
Mailing Address - Country:US
Mailing Address - Phone:570-346-3686
Mailing Address - Fax:570-346-5301
Practice Address - Street 1:340 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1782
Practice Address - Country:US
Practice Address - Phone:570-346-3686
Practice Address - Fax:570-346-5301
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041016L2084P0800X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011429780008Medicaid
PAE64196Medicare UPIN
PAE64196Medicare UPIN
PA523331Medicare ID - Type UnspecifiedPERSONAL
PABE523331OtherPEBTF
PA260048423Medicare ID - Type UnspecifiedRAIL ROAD INDIVIDUAL
PA0011429780008Medicaid
PA118759300OtherDEPARTMENT OF LABOR
PA0013415OtherTRI CARE INDIVIDUAL
PA118576OtherMANAGED HEALTH NETWORK
PA305292OtherMANAGED HEALTH NET GROUP
PA523331OtherBLUE SHIELD - INDIVIDUAL
PA804322OtherFIRST PRIORITY
PA27M002OtherEMPIRE BLUE CROSS