Healthcare Provider Details

I. General information

NPI: 1649631888
Provider Name (Legal Business Name): FRED J BERGANINI BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 UNIVERSITY DR NW SUITE A14
HUNTSVILLE AL
35806-1757
US

IV. Provider business mailing address

6125 UNIVERSITY DR NW SUITE A14
HUNTSVILLE AL
35806-1757
US

V. Phone/Fax

Practice location:
  • Phone: 256-922-0004
  • Fax:
Mailing address:
  • Phone: 256-922-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4186
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: