Provider Demographics
NPI:1366430027
Name:BERGER, SCOTT B (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:B
Last Name:BERGER
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 1:2501 OREGON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4890
Mailing Address - Country:US
Mailing Address - Phone:717-293-3223
Mailing Address - Fax:717-390-2455
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-797-7322
Practice Address - Fax:203-743-2610
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0352802085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44966Medicare UPIN
NY300136368Medicare PIN
CT300003616Medicare PIN
NY735S81Medicare PIN
CT300002220Medicare PIN
CT300091466Medicare PIN