Provider Demographics
NPI:1063250819
Name:BERG, SAMANTHA KAREN (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAREN
Last Name:BERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3358
Mailing Address - Country:US
Mailing Address - Phone:407-590-7701
Mailing Address - Fax:
Practice Address - Street 1:1000 HILLTOP CIR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250-0001
Practice Address - Country:US
Practice Address - Phone:410-455-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program