Provider Demographics
NPI:1629058631
Name:BERGAN, CATHERINE M (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:BERGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 MCDANIEL DR STE 50
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-7030
Mailing Address - Country:US
Mailing Address - Phone:484-905-8000
Mailing Address - Fax:484-905-8005
Practice Address - Street 1:1601 MCDANIEL DR STE 50
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-7030
Practice Address - Country:US
Practice Address - Phone:484-905-8000
Practice Address - Fax:484-905-8005
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008603L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G36449Medicare UPIN
PA893695HK1Medicare PIN
G36449Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE