Provider Demographics
NPI:1922091537
Name:BERGESE, MARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:BERGESE
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 1:1211 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1091
Mailing Address - Country:US
Mailing Address - Phone:614-486-5207
Mailing Address - Fax:
Practice Address - Street 1:1211 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1091
Practice Address - Country:US
Practice Address - Phone:614-486-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076518B207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000211188OtherANTHEM
OH2309380Medicaid
OH7209300OtherAETNA
OH2900919OtherUNITED HEALTHCARE
OHH54477Medicare UPIN
OH000000211188OtherANTHEM