Provider Demographics
NPI:1861596058
Name:BERGER, MARC STUART (MD,CM)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:STUART
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD,CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3816
Mailing Address - Country:US
Mailing Address - Phone:727-600-9205
Mailing Address - Fax:614-386-9410
Practice Address - Street 1:4200 W CYPRESS ST STE 690
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4112
Practice Address - Country:US
Practice Address - Phone:813-877-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66567207Q00000X, 207QG0300X
FLME-81929207Q00000X, 207QG0300X
TXFTP 45348207Q00000X
TXR0996207QG0300X
FLME81929207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37771OtherFL BLUE SHIELD
TX356072401Medicaid
FLME 81929OtherFLORIDA MEDICAL LICENSE
GA003113557AMedicaid
GA66567OtherGEORGIA MEDICAL LICENSE
TXR0996OtherMEDICAL LICENSE TX
FL263050800Medicaid
TX356072402OtherMEDICAID-CSHCN
TX356072402OtherMEDICAID-CSHCN
TX473041ZK0DMedicare PIN
TX356072401Medicaid