Basic Information
| Provider Information | |||||||||
| NPI: | 1780657122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERG | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD, FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 ROBIN WAY | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206265485 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 WELCH RD STE 435 | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | G146366 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | ZWCGCR | 01 | AZ | GROUP MEDICARE NUMBER | OTHER | 344549 | 05 | AZ | MEDICAID | 370019429 | 01 | AZ | RR MEDICARE | OTHER |