1942202692 NPI number — KERNAN DENTISTRY

Table of content: MRS. MEG ANN BERGESON NP (NPI 1144452368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942202692 NPI number — KERNAN DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERNAN DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1942202692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 KERNAN DR
Provider Second Line Business Practice Location Address:
DENTAL SUITE T500
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21207-6665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-448-6290
Provider Business Practice Location Address Fax Number:
410-448-6883
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOGIN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
410-448-6289

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , 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)

  • Identifier: 9282-1 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S165 . This is a "DENTAL NETWORK ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 105664 . This is a "DORAL DENTAL LOCATION ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 164252 . This is a "DORAL DENTAL PAYOR ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 800194400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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