1417952987 NPI number — LOUIS JOHN BERGES JR. MD

Table of content: LOUIS JOHN BERGES JR. MD (NPI 1417952987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417952987 NPI number — LOUIS JOHN BERGES JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGES
Provider First Name:
LOUIS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417952987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 READS WAY
Provider Second Line Business Mailing Address:
SUITE# 201
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-709-4510
Provider Business Mailing Address Fax Number:
302-356-9304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 MIDDLEFORD RD
Provider Second Line Business Practice Location Address:
NANTICOKE HOSPITAL
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-629-6611
Provider Business Practice Location Address Fax Number:
302-628-6359
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD040148E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1106503 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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