Berg, Mary Ellen

Berg, Mary Ellen is an individual health care provider with primary practice located at 471 Ashley Ridge Blvd , Shreveport LA 71106. She recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as her primary health care specialty. Berg, Mary Ellen can be contacted via phone (318) 795-4770.

Contact Information

Primary practice address
471 Ashley Ridge Blvd Shreveport LA 71106
Phone: (318) 795-4770
Fax: (318) 795-4775
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 019001 Louisiana

Profile Details

NPI number 1174524391
LBN Legal business name Berg, Mary Ellen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Dec 11th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174524391 NPPES
Arkansas Other 123802001 ARKANSAS MEDICAID
Arkansas Other 1053315846 ARKANSAS MEDICAID
Arkansas MEDICAID 1922871 ARKANSAS MEDICAID
Arkansas Other 078737601 ARKANSAS MEDICAID
Arkansas Other P00375906 ARKANSAS MEDICAID

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