Provider Demographics
NPI:1669448031
Name:OVERHOLT, BERGEIN FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:BERGEIN
Middle Name:FREDERICK
Last Name:OVERHOLT
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:PO BOX 59002
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-9002
Mailing Address - Country:US
Mailing Address - Phone:865-588-5121
Mailing Address - Fax:865-588-2126
Practice Address - Street 1:1311 DOWELL SPRINGS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2454
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:865-588-2126
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD04123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008660Medicaid
B02125Medicare UPIN
3145535Medicare PIN