Provider Demographics
NPI:1447248489
Name:BERG, ALAN BENJAMIN (MD, MPH, MSS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BENJAMIN
Last Name:BERG
Suffix:
Gender:M
Credentials:MD, MPH, MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 EMDG/CC
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09309
Mailing Address - Country:QA
Mailing Address - Phone:318-437-3796
Mailing Address - Fax:318-437-8705
Practice Address - Street 1:379 EMDG/CC
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09309
Practice Address - Country:QA
Practice Address - Phone:318-437-3796
Practice Address - Fax:318-437-8705
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD19502083A0100X
NM92-1822083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine