Provider Demographics
NPI:1326052234
Name:BERGSMA, DONALD R JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:BERGSMA
Suffix:JR
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 1:800 W CEMETARY ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3212
Mailing Address - Country:US
Mailing Address - Phone:704-633-0345
Mailing Address - Fax:704-636-4981
Practice Address - Street 1:800 W CEMETARY ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-633-0345
Practice Address - Fax:704-636-4981
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911758Medicaid
NC9800469OtherNC MEDICAL BOARD
NC8911758Medicaid