Provider Demographics
NPI:1306997135
Name:BERGER, SALLY C (MD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:C
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD STE 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3421
Mailing Address - Country:US
Mailing Address - Phone:303-272-0768
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST
Practice Address - Street 2:STE 460
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3666
Practice Address - Country:US
Practice Address - Phone:303-318-2500
Practice Address - Fax:303-318-2575
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01283217Medicaid
COCO306771Medicare PIN
COC400348Medicare PIN
COE21784Medicare UPIN
COC43228Medicare PIN