Provider Demographics
NPI:1881684090
Name:BERGER, JEFFREY (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 23RD ST NW
Mailing Address - Street 2:SUITE G-2092
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2342
Mailing Address - Country:US
Mailing Address - Phone:202-715-5213
Mailing Address - Fax:202-715-4759
Practice Address - Street 1:900 23RD ST NW
Practice Address - Street 2:SUITE G-2092
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-5213
Practice Address - Fax:202-715-4759
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226090207L00000X
DCMD036299207L00000X
MDD0064971207L00000X
VA0101240376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640820Medicaid
NY0288T1Medicare ID - Type Unspecified