Provider Demographics
NPI:1487811824
Name:BRIAN D. BERGER, MD, PA
Entity type:Organization
Organization Name:BRIAN D. BERGER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-391-6707
Mailing Address - Street 1:1341 DAVID ST
Mailing Address - Street 2:#111
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1916
Mailing Address - Country:US
Mailing Address - Phone:650-391-6707
Mailing Address - Fax:
Practice Address - Street 1:1341 DAVID ST
Practice Address - Street 2:#111
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1916
Practice Address - Country:US
Practice Address - Phone:650-391-6707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL21352085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH50231Medicare UPIN
TX8C751100554XMedicare PIN