Provider Demographics
NPI:1639602402
Name:BERGMEYER, MARIE LUISE (D0)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LUISE
Last Name:BERGMEYER
Suffix:
Gender:F
Credentials:D0
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 OLD WATERLOO RD APT 316
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7152
Mailing Address - Country:US
Mailing Address - Phone:917-669-3731
Mailing Address - Fax:
Practice Address - Street 1:6755 OLD WATERLOO RD APT 316
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7152
Practice Address - Country:US
Practice Address - Phone:917-669-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0087699208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice