Provider Demographics
NPI:1982764502
Name:BERGER, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
Mailing Address - Street 2:2101 EAST JEFFERSON STREET
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4512
Practice Address - Country:US
Practice Address - Phone:703-383-5400
Practice Address - Fax:703-383-5547
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD22142163WU0100X
VA0101032497163WU0100X
DCMD31255163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010646M92Medicare ID - Type Unspecified
D06031Medicare UPIN