Provider Demographics
NPI:1649265943
Name:BERGER, MARK G (PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:BERGER
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3300 ACADEMY AVE
Mailing Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3205
Mailing Address - Country:US
Mailing Address - Phone:757-483-6404
Mailing Address - Fax:757-483-0737
Practice Address - Street 1:3300 ACADEMY AVE
Practice Address - Street 2:ACADEMY CROSSING MEDICAL PLAZA
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3205
Practice Address - Country:US
Practice Address - Phone:757-483-6404
Practice Address - Fax:757-483-0737
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810000978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ80700OtherSENTARA
VA027831OtherANTHEM