Provider Demographics
NPI:1588636302
Name:BERGMAN, IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
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 1:3705 5TH AVE
Mailing Address - Street 2:ROOM 2950
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2524
Mailing Address - Country:US
Mailing Address - Phone:412-692-5520
Mailing Address - Fax:
Practice Address - Street 1:3705 5TH AVE
Practice Address - Street 2:ROOM 2950
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2524
Practice Address - Country:US
Practice Address - Phone:412-692-5520
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022524E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106128EB0Medicare ID - Type Unspecified
PAC03266Medicare UPIN