Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD441701 | PA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | P2593 | TX |
Y | 207YP0228X | Pediatric Otolaryngology | 78940 | GA |
N | 207YP0228X | Pediatric Otolaryngology | MD441701 | PA |
N | 207YP0228X | Pediatric Otolaryngology | P2593 | TX |
NPI | 1265619696 |
---|---|
Provider Name | Dr. Eric Edward Berg |
First Address | Atlanta, GA 30342-3009 |
Second Address | Atlanta, GA 30342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003199122 | (05) | GA |