Provider Demographics
NPI:1063469112
Name:BERGMAN, ALF H (MD)
Entity Type:Individual
Prefix:
First Name:ALF
Middle Name:H
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 ROCKSIDE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4807 ROCKSIDE RD
Practice Address - Street 2:STE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6802
Practice Address - Country:US
Practice Address - Phone:216-503-9489
Practice Address - Fax:216-503-9492
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350937612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987344Medicaid
OH2987344Medicaid
OHH067781Medicare PIN