Provider Demographics
NPI:1992798920
Name:BERG, ALAN MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MITCHELL
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2625 W ALAMEDA AVE
Mailing Address - Street 2:208
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4806
Mailing Address - Country:US
Mailing Address - Phone:818-845-3557
Mailing Address - Fax:818-845-2600
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:208
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-845-3557
Practice Address - Fax:818-845-2600
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG34555207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G345551Medicaid
CAWG34555EMedicare ID - Type Unspecified
CAWG34555DMedicare ID - Type Unspecified
CA00G345551Medicaid