Provider Demographics
NPI:1265404909
Name:VANBERGEN, RICHARD ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDREW
Last Name:VANBERGEN
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 1:600 JEFFERSON ST
Mailing Address - Street 2:STE 301
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6987
Mailing Address - Country:US
Mailing Address - Phone:337-470-2180
Mailing Address - Fax:337-470-2677
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-367-1048
Practice Address - Fax:337-367-0131
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000214142085R0202X
GA0508492085R0202X
FLME851462085R0202X
LA10760R2085R0202X
LAMD.10760R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10760ROtherMEDICAL LICENSE
LA1486221Medicaid
G65584Medicare UPIN