Provider Demographics
NPI:1760136584
Name:BERGERON, EMILIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133, RUE LUC-LACOURVIERE
Mailing Address - Street 2:
Mailing Address - City:QUEBEC CITY
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:G1X4V5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MASS EYE AND EAR
Practice Address - Street 2:243 CHARLES STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-573-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program