DR. JACOB BERGER (NPI# 1457413379) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457413379 |
| Entity Type | Individual |
| Full Name | DR. JACOB BERGER |
| Credential | M.D. |
| Practice Address |
830 Chalkstone Ave Providence Va Medical Center, Dept of Neurology Providence RI 02908-4734 |
| Practice Telephone | 4012737100 |
| Mailing Telephone | 4012737100 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2010-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD12584 | RI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | RI LICENSE | 12584 | 01 |
| NY | DEA | BB9102663 | 01 |
| NY | UHC | 2575620 | 01 |
| NY | OXFORD | P3628039 | 01 |
| NY | 02682699 | 05 | |
| NY | MVP | 790791 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447706205 | Jacob P. Berger | Dentist | 2215 University Pkwy, 103, Sarasota, FL 34243-7233 | 2016-08-31 |
| 1720317779 | Jacob E. Berger | Counselor | 4525 Henry Hudson Pkwy Apt 810, Bronx, NY 10471-3811 | 2009-12-21 |
| Street Address |
830 CHALKSTONE AVE PROVIDENCE VA MEDICAL CENTER, DEPT OF NEUROLOGY |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02908-4734 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174510853 | Frances Ann Bettencourt | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2005-09-29 |
| 1881295277 | Johnna Bussiere | Nurse's Aide | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-11-03 |
| 1770196578 | Caroline Sophie Holman | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-31 |
| 1104437458 | Vivian Vang | Registered Nurse | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-11 |
| 1841800604 | Wilcania Baez | Social Worker | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-08-06 |
| 1609484757 | Stephen Soonbeom Kwon | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1972111029 | Keenan Sandouk | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1952919011 | Yumna Arif | Student in an Organized Health Care Education/Training Program | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-07-15 |
| 1760009518 | Hassan Saada | Nurse Practitioner | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-28 |
| 1952927675 | Susannah Kondrath | Psychologist | 830 Chalkstone Ave, Providence, RI 02908-4734 | 2020-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771900 | Horizon Wellness | Clinic/Center | 1339 Smith St, North Providence, RI 02908 | 2017-10-12 |
| 1477098069 | Beth Perry | Nurse Practitioner | 830 Chalstone Ave., Providence, RI 02908 | 2017-01-05 |
| 1659788735 | Brandi Kimble | Podiatrist | 825 Chalkstone Avenue, Providence, RI 02908 | 2014-07-21 |
| 1912253675 | Roger Williams Medical Center | Long Term Care Hospital | 25 Chalkstone Ave, Providence, RI 02908 | 2012-07-31 |
| 1669768818 | Elisa Semedo | Physical Therapist | 285 Promenade Street, Providence, RI 02908 | 2011-06-27 |
| 1255655502 | Caregiver Homes of Rhode Island Inc. | Custodial Care Facility | 235 Promenade Street, Providence, RI 02908 | 2010-03-16 |
| 1487884987 | Professional Ambulance LLC | Ambulance | 52 River Ave, Providence, RI 02908 | 2009-07-17 |
| 1609065804 | Stephen W Davis | Family Medicine | 299 Promenade Street, Nhpri, Providence, RI 02908 | 2007-10-24 |
| 1205053899 | John R Ricci | Dentist | 1252 Smith St, Providence, RI 02908 | 2007-04-18 |
| 1871718718 | Brett C Auclaire | Nurse Practitioner | 40 Candace Street, Providence, RI 02908 | 2007-04-16 |
| Find all providers in zip 02908 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215597000 | Liqi Shu | Psychiatry & Neurology | Rhode Island Hospital, 593 Eddy St, Providence, RI 02903-4923 | 2019-06-14 |
| 1396703294 | Israel Yaar | Psychiatry & Neurology | Davis Park (127a), Va Medical Center, Providence, RI 02908 | 2006-05-02 |
| 1720045438 | Stephen T Mernoff | Psychiatry & Neurology | 877 Chalkstone Ave, Providence, RI 02908-4728 | 2006-04-27 |
| 1184609398 | Michael A Friedman | Psychiatry & Neurology | 146 W River St, Suite 11b, Providence, RI 02904-2609 | 2005-12-09 |
| 1518580703 | Sanaya Daruvala | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2020-05-21 |
| 1699398933 | Macdonell Stanford | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2020-05-21 |
| 1376101162 | Daniel Mandel | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2019-06-05 |
| 1952968125 | Cody Sanders | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2019-05-23 |
| 1407413578 | Maheen Rana | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2019-05-23 |
| 1679069900 | Natalie Erlich-malona | Psychiatry & Neurology | 593 Eddy St, Providence, RI 02903-4923 | 2018-07-10 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02908 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.