Provider Demographics
NPI:1629179932
Name:BERGMAN, ARIEH (MD,)
Entity Type:Individual
Prefix:
First Name:ARIEH
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 1:349 S SWALL DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3611
Mailing Address - Country:US
Mailing Address - Phone:310-652-7331
Mailing Address - Fax:310-653-6361
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 207
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-881-8999
Practice Address - Fax:818-881-9301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41085207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85568Medicare UPIN
CAP00173999Medicare ID - Type UnspecifiedMEDICARE RAILROAD CARRIER