Provider Demographics
NPI:1922295278
Name:BERTA M BERGIA MD PC
Entity Type:Organization
Organization Name:BERTA M BERGIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PHYSICIAN NEUROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-531-6161
Mailing Address - Street 1:9333 PARK WEST BLVD
Mailing Address - Street 2:#108
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4305
Mailing Address - Country:US
Mailing Address - Phone:865-531-6161
Mailing Address - Fax:865-691-3691
Practice Address - Street 1:9333 PARK WEST BLVD
Practice Address - Street 2:#108
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4305
Practice Address - Country:US
Practice Address - Phone:865-531-6161
Practice Address - Fax:865-691-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN178492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3026559Medicaid
TN3026559Medicare UPIN