Provider Demographics
NPI:1518957067
Name:BERGWITZ, CLEMENS (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENS
Middle Name:
Last Name:BERGWITZ
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 1:1 GILBERT ST
Mailing Address - Street 2:ANLYAN CENTER, TAC S117
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8720
Mailing Address - Fax:
Practice Address - Street 1:35 PARK ST
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL, SMILOW CANCER CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1110
Practice Address - Country:US
Practice Address - Phone:203-200-3636
Practice Address - Fax:203-200-2159
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52826207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism