1932113164 NPI number — DAIVD TOBIAS BERGER

Table of content: DAIVD TOBIAS BERGER (NPI 1932113164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932113164 NPI number — DAIVD TOBIAS BERGER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGER
Provider First Name:
DAIVD
Provider Middle Name:
TOBIAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1932113164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 S MEADOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 PLEASANT STREET
Provider Second Line Business Practice Location Address:
CENTER FOR INTEGRATIVE MEDICINE
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

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: 101YM0800X , with the licence number:  328 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 39176 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: 2170 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: 10510 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 30011572 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Y004863NH01 . This is a "MENTAL HEALTH COUNSELOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6175598 . This is a "PHYSICAL THERAPY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0805192Y0NH01 . This is a "PHYSICAL THERAPY" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2194835 . This is a "MENTAL HEALTH COUNSELOR" identifier . This identifiers is of the category "OTHER".