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Individual

DR. JACOB BERGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
830 CHALKSTONE AVE, PROVIDENCE VA MEDICAL CENTER, DEPT OF NEUROLOGY, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
830 CHALKSTONE AVE, PROVIDENCE VA MEDICAL CENTER, DEPT OF NEUROLOGY, PROVIDENCE, RI 02908-4734
(401) 273-7100

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD12584
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02682699
NY
01
12584
RI LICENSE
RI
01
2575620
UHC
NY
01
790791
MVP
NY
01
P3628039
OXFORD
NY
Enumeration date
12/15/2006
Last updated
03/07/2023
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