Provider Demographics
NPI:1669701694
Name:BERGERON, CATHERINE WACHTER (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:WACHTER
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 KEMPSVILLE RD
Mailing Address - Street 2:1ST FL
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-8070
Mailing Address - Fax:757-995-7095
Practice Address - Street 1:830 KEMPSVILLE RD
Practice Address - Street 2:1ST FL
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-8070
Practice Address - Fax:757-995-7095
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101253674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program