Provider Demographics
NPI:1073506523
Name:BERG, EUGENE ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ELLIOT
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 CHARLES BANCROFT HWY
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6912
Practice Address - Country:US
Practice Address - Phone:603-472-8888
Practice Address - Fax:603-472-9090
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9793207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010506Medicaid
NH30010506Medicaid
RE4511Medicare PIN