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NPI Code Detail

MEDICARE: KELLY A BERGIVEN RD, LDN

MEDICARE: KELLY A BERGIVEN RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDN000155PA

General Provider Information

NPI Number : 1295816981
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY A BERGIVEN RD, LDN
Provider Business Mailing Address
First Line : 1119 TABOR TER
Second Line :
City : PHILA
State : PA
Zip : 19111-1428
Country : US
Telephone Number : 215-722-6435
Fax Number :
Provider Business Practice Location Address
First Line : 1205 LANGHORNE NEWTOWN RD
Second Line :
City : LANGHORNE
State : PA
Zip : 19047-1219
Country : US
Telephone Number : 215-710-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 07/08/2007

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Directions to “ KELLY A BERGIVEN RD, LDN” Practice Location

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