Provider Demographics
NPI:1760404917
Name:BERGFIELD, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:BERGFIELD
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 1:814 GREENBRIER CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2643
Mailing Address - Country:US
Mailing Address - Phone:757-547-5145
Mailing Address - Fax:
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:STE. 100
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-547-5145
Practice Address - Fax:757-539-7488
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035059207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006406092Medicaid
VA200030435OtherMEDICARE RR
VAVV4847AMedicare PIN
VA006406092Medicaid
VA200030435OtherMEDICARE RR
VA015952O04Medicare PIN
VA400000014Medicare PIN