Provider Demographics
NPI:1811934557
Name:BERGER, BRIAN MAX (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MAX
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 1:2300 CROWN COLONY DR
Mailing Address - Street 2:BOSTON IVF- THE SOUTH SHORE CENTER
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0902
Mailing Address - Country:US
Mailing Address - Phone:617-793-1100
Mailing Address - Fax:617-793-1175
Practice Address - Street 1:2300 CROWN COLONY DR
Practice Address - Street 2:BOSTON IVF- THE SOUTH SHORE CENTER
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0902
Practice Address - Country:US
Practice Address - Phone:617-793-1100
Practice Address - Fax:617-793-1175
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157527207VE0102X, 207VG0400X
RIMD10797207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA28506Medicare ID - Type Unspecified
MAG15030Medicare UPIN