Provider Demographics
NPI:1265452023
Name:BERGAMO, BETHANY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:BERGAMO
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 1:315 19TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4230
Mailing Address - Country:US
Mailing Address - Phone:828-325-9849
Mailing Address - Fax:828-325-9879
Practice Address - Street 1:1927 3RD AVENUE LN SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2960
Practice Address - Country:US
Practice Address - Phone:828-328-3500
Practice Address - Fax:828-328-8777
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401471207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH33835Medicare UPIN
NC2037200Medicare PIN