Provider Demographics
NPI:1023040409
Name:BERGQUIST, NOEL MELINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:MELINDA
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST # 376
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-7234
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST # 376
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7234
Practice Address - Fax:423-778-6811
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0530982085R0202X
AL276262085R0202X
FL1073562085R0202X
NC2005-006992085R0202X
TN472042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBFQOtherMEDICARE - IDTF COLUMBUS DIAGNOSTIC
GAGRP2151OtherMEDICARE GROUP NUMBER COLUMBUS DIAGNOSTIC
TNQ009031Medicaid