STEPHANIE ANN BERG DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059999

License Status

CANCELLED

Business

Title

First Name

STEPHANIE

Middle

ANN

Last Name

BERG

Business Name

STEPHANIE ANN BERG DO

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2014

City

NEEDHAM

State

Zip

02492

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/19/2011