Provider Demographics
NPI:1467412791
Name:BERGMAN, DAVID MOSHE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MOSHE
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 1:9570 NESBIT FERRY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6859
Mailing Address - Country:US
Mailing Address - Phone:770-640-8119
Mailing Address - Fax:770-988-5553
Practice Address - Street 1:9570 NESBIT FERRY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6859
Practice Address - Country:US
Practice Address - Phone:770-640-8119
Practice Address - Fax:770-988-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051116208000000X
UT3085901-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000938704IMedicaid
H12494Medicare UPIN