Provider Demographics
NPI:1518921972
Name:BERGEN, JOSEPH M (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:BERGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4159
Mailing Address - Country:US
Mailing Address - Phone:978-287-3697
Mailing Address - Fax:978-287-3674
Practice Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:E.D.
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3697
Practice Address - Fax:978-287-3674
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81816207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3154475Medicaid
MA3154475Medicaid
MAG33289Medicare UPIN