Provider Demographics
NPI:1982365128
Name:BERG, AMANDA FLORENCE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FLORENCE
Last Name:BERG
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3502
Mailing Address - Country:US
Mailing Address - Phone:857-344-0545
Mailing Address - Fax:
Practice Address - Street 1:21 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3502
Practice Address - Country:US
Practice Address - Phone:857-455-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA9270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant