Provider Demographics
NPI:1669431805
Name:BERGMANN, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5535 FAIR LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3434
Mailing Address - Country:US
Mailing Address - Phone:513-221-5274
Mailing Address - Fax:513-961-5100
Practice Address - Street 1:2859 BOUDINOT AVE
Practice Address - Street 2:STE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-1606
Practice Address - Country:US
Practice Address - Phone:513-661-3566
Practice Address - Fax:513-661-6469
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-12-31
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Provider Licenses
StateLicense IDTaxonomies
OH35-049117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0688548Medicaid
OH180032729OtherRAILROAD MEDICARE
OH0606584Medicare PIN
OH0606586Medicare PIN
OH0606582Medicare PIN
OH180032729OtherRAILROAD MEDICARE
OHA82863Medicare UPIN
OH0688548Medicaid
OH0606583Medicare PIN