Provider Demographics
NPI:1962468306
Name:BERGMAN, CHARLES ANDREW JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:BERGMAN
Suffix:JR
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 1:1040 PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5634
Mailing Address - Country:US
Mailing Address - Phone:443-738-0300
Mailing Address - Fax:
Practice Address - Street 1:1040 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5634
Practice Address - Country:US
Practice Address - Phone:443-738-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD32816207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207891100Medicaid
MDD76139Medicare UPIN