Provider Demographics
NPI:1770853855
Name:JOSEPH W BERGERON, M.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH W BERGERON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-238-3030
Mailing Address - Street 1:3740 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5507
Mailing Address - Country:US
Mailing Address - Phone:812-238-3030
Mailing Address - Fax:469-398-0741
Practice Address - Street 1:3740 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5507
Practice Address - Country:US
Practice Address - Phone:812-238-3030
Practice Address - Fax:469-398-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044440A208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01044440AOtherINDIANA PHYSICIAN'S MEDICAL LICENSE
IN01044440AOtherINDIANA PHYSICIAN'S MEDICAL LICENSE
ING18520Medicare UPIN