1235282468 NPI number — CRAIG BERGER MD PL

Table of content: (NPI 1235282468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235282468 NPI number — CRAIG BERGER MD PL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG BERGER MD PL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1235282468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3242 COVE BEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613-2752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-265-6940
Provider Business Mailing Address Fax Number:
813-908-3937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3242 COVE BEND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-2752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-265-6940
Provider Business Practice Location Address Fax Number:
813-908-3937
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-765-6309

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME71875 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AG836 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009826500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com