1497841159 NPI number — DR. MONIKA BERG MD

Table of content: DR. MONIKA BERG MD (NPI 1497841159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497841159 NPI number — DR. MONIKA BERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERG
Provider First Name:
MONIKA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1497841159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 FRANKLIN ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-872-2220
Provider Business Mailing Address Fax Number:
508-872-2270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-872-2220
Provider Business Practice Location Address Fax Number:
508-872-2270
Provider Enumeration Date:
10/04/2006

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: 207N00000X , with the licence number:  35755 , 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: 4105 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: B18195 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 711353 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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