Provider Demographics
NPI:1750426631
Name:BERG, ERIC CHRISTOPHER (CRNA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:BERG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 WOODLAND PARK
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-5672
Mailing Address - Fax:
Practice Address - Street 1:115 PORTER DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0027388367500000X
NH058370-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013329Medicaid
NH30346738Medicaid
VT69763OtherBLUE CROSS BLUE SHIELD
VT69763OtherBLUE CROSS BLUE SHIELD
VT1013329Medicaid