| Doctor Name: | DR. STEPHEN RUSSELL BERGMAN |
| NPI Number: | 1609021104 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 2007018743 |
| Business Practice Address: | 95 Park St Suite 519 Lewiston, ME - 042407282 |
| Business Phone Number: | 2072410945 |
| Business Fax Number: | 2072410955 |
| Mailing Address: | 95 Park St, Suite 519 LEWISTON |
| State: | ME |
| Postal Code: | 042407282 |
| Phone Number: | 2072410945 |
| Fax Number: | 2072410955 |
| NPI Enumeration Date: | 11/25/2008 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2007018743 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |