Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 133568-1 | NY |
N | 111NI0900X | Internist | 133568-1 | NY |
Y | 207R00000X | Internist | MD012582E | PA |
Y | 111NI0900X | Internist | MD012582E | PA |
N | 207RG0300X | Geriatric Medicine | MD012582E | PA |
NPI | 1043304041 |
---|---|
Provider Name | Dr. Herbert M Bergman |
First Address | Yardley, PA 19067-7424 |
Second Address | Philadelphia, PA 19152-2081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000592556 | (05) | PA |
0053907001 | KEYSTONE HEALTH PLAN EAST (01) | PA |
110026458 | PALMETTO GBA MEDICARE RR (01) | PA |
835253 | AETNA INSURANCE (01) | PA |
C28291 | (02) | PA |