1649263286 NPI number — DR. RONALD H BERGER MD

Table of content: DR. RONALD H BERGER MD (NPI 1649263286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649263286 NPI number — DR. RONALD H BERGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGER
Provider First Name:
RONALD
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1649263286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 BIRNIE AVE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01107-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-734-4206
Provider Business Mailing Address Fax Number:
413-737-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BIRNIE AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-734-4206
Provider Business Practice Location Address Fax Number:
413-737-8882
Provider Enumeration Date:
08/30/2005

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: 207R00000X , with the licence number:  46081 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y02234 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0172782 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com