MEDICARE: CARL T BERGREN MD

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
1	207Q00000X	Family Medicine Physician	90704	SC
2	2086S0102X	Surgical Critical Care Physician	26994	OK

General Provider Information

NPI Number	:	1417936394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL T BERGREN MD

Provider Business Mailing Address
First Line	:	3226 MAYBANK HWY STE C
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4860
Country	:	US
Telephone Number	:	843-266-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3226 MAYBANK HWY STE C
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4860
Country	:	US
Telephone Number	:	843-266-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/22/2025

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Directions to “ CARL T BERGREN MD” Practice Location

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