Provider Demographics
NPI:1215950084
Name:BERGER, MARC S V (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:S
Last Name:BERGER
Suffix:V
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:P.O. BOX 821868
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75382-1868
Mailing Address - Country:US
Mailing Address - Phone:214-341-8770
Mailing Address - Fax:214-341-1603
Practice Address - Street 1:12840 HILLCREST PLAZA DRIVE
Practice Address - Street 2:SUITE E100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1532
Practice Address - Country:US
Practice Address - Phone:214-341-8770
Practice Address - Fax:214-341-1603
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7821174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicaid