Provider Demographics
NPI:1649589227
Name:BERG, CAROLYN M (MD)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:M
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8110 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2291
Mailing Address - Country:US
Mailing Address - Phone:918-583-4400
Mailing Address - Fax:918-583-7908
Practice Address - Street 1:8110 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2291
Practice Address - Country:US
Practice Address - Phone:918-583-4400
Practice Address - Fax:918-583-7908
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6172208600000X, 2086S0105X
OK31095208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200573930AMedicaid