Provider Demographics
NPI:1992797948
Name:BERGER, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:30262 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRUCETON
Mailing Address - State:TN
Mailing Address - Zip Code:38317-2220
Mailing Address - Country:US
Mailing Address - Phone:731-586-2021
Mailing Address - Fax:731-586-4746
Practice Address - Street 1:30262 BROAD ST
Practice Address - Street 2:
Practice Address - City:BRUCETON
Practice Address - State:TN
Practice Address - Zip Code:38317-2220
Practice Address - Country:US
Practice Address - Phone:731-586-2021
Practice Address - Fax:731-586-4746
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 18376174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3029299Medicare ID - Type UnspecifiedMEDICARE/MEDICAID
TNA99324Medicare UPIN