Provider Demographics
NPI:1588811467
Name:BERGSTROM, CHRISTINA NG (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NG
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3404
Mailing Address - Country:US
Mailing Address - Phone:360-735-8100
Mailing Address - Fax:360-253-1781
Practice Address - Street 1:16811 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3404
Practice Address - Country:US
Practice Address - Phone:360-735-8100
Practice Address - Fax:360-253-1781
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60087862207Q00000X
ORMD160810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01238398OtherRR MEDICARE (PH&S)
OR213006Medicaid
ORP01238398OtherRR MEDICARE (PH&S)
ORR170377Medicare PIN
ORR170382Medicare PIN
ORR170378Medicare PIN
ORR173118Medicare PIN
ORR170381Medicare PIN
WAG8885969Medicare PIN
ORR170380Medicare PIN
ORR172557Medicare PIN
WAG8920946Medicare PIN