Provider Demographics
NPI:1356448971
Name:BERGMAN, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BERGMAN
Suffix:
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 1:3402 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3801
Mailing Address - Country:US
Mailing Address - Phone:412-486-3181
Mailing Address - Fax:412-487-3565
Practice Address - Street 1:3402 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3801
Practice Address - Country:US
Practice Address - Phone:412-486-3181
Practice Address - Fax:412-487-3565
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044548E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012553720004Medicaid
PA0012553720004Medicaid
PA671417KL5Medicare ID - Type Unspecified