MRS. MARY E. BERGMAN (NPI# 1497059729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497059729 |
| Entity Type | Individual |
| Full Name | MRS. MARY E. BERGMAN |
| Credential | PA-C |
| Practice Address |
2580 Frontage Rd Petersburg VA 23805-9309 |
| Practice Telephone | 8047320202 |
| Practice Fax Number | 8554977267 |
| Mailing Telephone | 8047320202 |
| Mailing Fax Number | 8554977267 |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2016-02-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0110003446 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | MB2907193 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164740544 | Mary Lee Bergman | Acupuncturist | 3079 E. Commercial Blvd, Suite 201, Fort Lauderdale, FL 33308-4311 | 2010-05-11 |
| 1861538159 | Mary Bergman | Social Worker | 1101 W University Dr, Rochester, MI 48307-1863 | 2007-01-30 |
| 1134187982 | Mary Catherine Bergman | Pediatrics | 3500 Gaston Ave, Baylor Univ Medical Center 5th Floor Truett, Dallas, TX 75246-2096 | 2006-05-02 |
| Street Address |
2580 FRONTAGE RD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386097822 | Healthstat Onsite Clinic Amsted Brenco | Preventive Medicine | 2580 Frontage Rd, Petersburg, VA 23805-9309 | 2016-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144794181 | Sarah G Liller | Physician Assistant | 10 Valley View Street, Suite 101, Petersburg, WV 26847-9205 | 2019-01-13 |
| 1982979464 | Ignatius Hall | Physician Assistant | 1090 River Rd, Petersburg, VA 23834 | 2012-03-15 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
| 1780186247 | Ashani Andrews | Physician Assistant | 210 Medical Park Blvd Ste 150, Petersburg, VA 23805-0001 | 2018-03-01 |
| 1053858423 | Douglas Cohrs | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2017-01-24 |
| 1154770766 | Adam Haymaker | Physician Assistant | 40 Medical Park Blvd, Suite B, Petersburg, VA 23805-9289 | 2016-06-06 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.