Provider Demographics
NPI:1669446134
Name:BERGREN, LYNN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:BERGREN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:620 JOHN PAUL JONES CIR
Mailing Address - Street 2:NAVAL MEDICAL CENTER
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-1204
Mailing Address - Fax:757-953-0805
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:NAVAL MEDICAL CENTER
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-1204
Practice Address - Fax:757-953-0805
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02002490A2085R0202X
GA0519112085R0202X
MN760712085R0202X
MI51010122332085R0202X
VA01022014092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology