1033149562 NPI number — DR. CATHERINE MELANIE BERGMANN PHD

Table of content: DR. CATHERINE MELANIE BERGMANN PHD (NPI 1033149562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033149562 NPI number — DR. CATHERINE MELANIE BERGMANN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGMANN
Provider First Name:
CATHERINE
Provider Middle Name:
MELANIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033149562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11215 OAK LEAF DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20901-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-593-1315
Provider Business Mailing Address Fax Number:
301-681-4699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11215 OAK LEAF DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20901-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-593-1315
Provider Business Practice Location Address Fax Number:
301-681-4699
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  04144 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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