Provider Demographics
NPI:1508872938
Name:BERGFELDER, PAUL ALLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLEN
Last Name:BERGFELDER
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 1:1915 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1212
Mailing Address - Country:US
Mailing Address - Phone:765-935-2567
Mailing Address - Fax:765-962-0880
Practice Address - Street 1:1915 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1212
Practice Address - Country:US
Practice Address - Phone:765-935-2567
Practice Address - Fax:765-962-0880
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030885A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256490CMedicaid
INM400060802Medicare PIN
D95687Medicare UPIN
INP01054896Medicare PIN