Provider Demographics
NPI:1558529875
Name:BERGLUND, KRISTINA W (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:W
Last Name:BERGLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241
Mailing Address - Country:US
Mailing Address - Phone:866-689-8862
Mailing Address - Fax:207-347-7401
Practice Address - Street 1:164 SUMMIT AVE.
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-793-2104
Practice Address - Fax:401-793-4047
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD13242207R00000X
MA232022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine