Provider Demographics
NPI:1093701682
Name:BERCKMUELLER, HUGH E (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:E
Last Name:BERCKMUELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD
Mailing Address - Street 2:#100
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-595-8404
Mailing Address - Fax:757-595-8353
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:#100
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-595-8404
Practice Address - Fax:757-595-8353
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056628207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282367OtherMAMSI/OPTIMUM CHOICE
VA22805OtherOPTIMA
VA317213OtherBLUE CROSS BLUE SHIELD
VA00630876Medicaid
VA22805OtherOPTIMA
VA1881655058Medicare PIN
VA317213OtherBLUE CROSS BLUE SHIELD
VA00630876Medicaid