1558388405 NPI number — LAWRENCE A BERGER MD PA

Table of content: (NPI 1558388405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558388405 NPI number — LAWRENCE A BERGER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE A BERGER MD PA
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:
1558388405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21097 NE 27TH CT
Provider Second Line Business Mailing Address:
#580
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-932-5551
Provider Business Mailing Address Fax Number:
305-932-2397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21097 NE 27TH CT
Provider Second Line Business Practice Location Address:
#580
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-932-5551
Provider Business Practice Location Address Fax Number:
305-932-2397
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
305-932-5551

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME0051685 , 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: 370256100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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