Provider Demographics
NPI:1881892859
Name:BERG, JONATHAN SANFORD (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SANFORD
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5092 GENETICS MEDICINE BUILDING
Mailing Address - Street 2:UNC - CHAPEL HILL, CB # 7264
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7264
Mailing Address - Country:US
Mailing Address - Phone:919-966-7043
Mailing Address - Fax:919-843-0291
Practice Address - Street 1:5092 GENETICS MEDICINE BUILDING
Practice Address - Street 2:UNC - CHAPEL HILL, CB # 7264
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7264
Practice Address - Country:US
Practice Address - Phone:919-966-7043
Practice Address - Fax:919-843-0291
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-00418207SG0201X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186355702Medicaid
TX186355701Medicaid
TX8J8887Medicare PIN
TX186355702Medicaid