Individual
MARY ELLEN BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1068 WINTERBERRY LN, SHREVEPORT, LA 71106-8551
(318) 469-8400
Mailing address
1068 WINTERBERRY LN, SHREVEPORT, LA 71106-8551
(318) 469-8400
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
019001
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078737601
TEXAS MEDICAID
TX
01
—
1053315846
GROUP MEDICARE NUMBER
LA
01
—
123802001
ARKANSAS MEDICAID
AR
05
—
1922871
—
LA
01
—
P00375906
RAILROAD MEDICARE
LA
Enumeration date
08/10/2005
Last updated
11/24/2025
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