Provider Demographics
NPI:1275501728
Name:BERGIA, BERTA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTA
Middle Name:M
Last Name:BERGIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BERTA
Other - Middle Name:M
Other - Last Name:BERGIA-CHAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:DEPT 888217
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8217
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:9352 PARK WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4325
Practice Address - Country:US
Practice Address - Phone:865-373-1974
Practice Address - Fax:865-373-1059
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN178492084N0600X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3026559Medicaid
TN3026559Other3026559
TNB58984Medicare UPIN
TN3026559Medicaid
TN3026559Medicare PIN