Individual
GEOFFREY HERBST BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
160 WAYLAND AVE, PROVIDENCE, RI 02906-4304
(401) 521-1221
(401) 454-4189
Mailing address
160 WAYLAND AVE, PROVIDENCE, RI 02906-4304
(401) 521-1221
(401) 454-4189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05035
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-02664
UNITED HEALTH CARE
—
01
—
2919
BCBS
RI
01
—
405576
BLUE CHIP
RI
01
—
455099
TUFTS
—
05
—
7001787
—
RI
Enumeration date
07/09/2005
Last updated
06/06/2012
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