Provider Demographics
NPI:1124286604
Name:BERG, DAVID ADAM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ADAM
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:120 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1938
Practice Address - Country:US
Practice Address - Phone:856-546-3900
Practice Address - Fax:856-546-3908
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2017-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08642000208600000X, 208C00000X
PAMD426634208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0212563Medicaid
NJ0212563Medicaid