Provider Demographics
NPI:1992962369
Name:BERGER, YANIV (DO)
Entity type:Individual
Prefix:DR
First Name:YANIV
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3742
Mailing Address - Country:US
Mailing Address - Phone:410-469-5544
Mailing Address - Fax:410-585-2867
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3742
Practice Address - Country:US
Practice Address - Phone:410-469-5544
Practice Address - Fax:410-585-2867
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0068214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157676Medicare PIN
MD135880ZD2XMedicare PIN