Doctor Name: | DR. TIMOTHY BERGAN |
NPI Number: | 1194922864 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 471 E C St Building Sp-64 Norfolk, VA - 235113905 |
Business Phone Number: | 7574433427 |
Business Fax Number: | |
Mailing Address: | 581 A St, Building Sp-312 NORFOLK |
State: | VA |
Postal Code: | 235114004 |
Phone Number: | 7574433427 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2007 |
NPI Last Update Date: | 03/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |