Provider Demographics
NPI:1013112796
Name:BERGERSEN, THOR CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOR
Middle Name:CHRISTIAN
Last Name:BERGERSEN
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 1:75 2ND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2820
Mailing Address - Country:US
Mailing Address - Phone:781-726-6698
Mailing Address - Fax:781-726-6725
Practice Address - Street 1:75 2ND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2820
Practice Address - Country:US
Practice Address - Phone:781-726-6698
Practice Address - Fax:781-726-6725
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2041232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry