Provider Demographics
NPI:1083175970
Name:BERGBOWER, EMILY ANNE SMITH (MD, PHD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE SMITH
Last Name:BERGBOWER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 S GREENE ST RM S11C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-6120
Mailing Address - Fax:410-328-5531
Practice Address - Street 1:22 S GREENE ST RM S11C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6120
Practice Address - Fax:410-328-5531
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD98321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology