Provider Demographics
NPI:1952768335
Name:BERG, BAREN
Entity Type:Individual
Prefix:
First Name:BAREN
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 GOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-1308
Mailing Address - Country:US
Mailing Address - Phone:814-441-4112
Mailing Address - Fax:
Practice Address - Street 1:26 S 2ND ST STE 101A
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2346
Practice Address - Country:US
Practice Address - Phone:814-441-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist