Healthcare Provider Details

I. General information

NPI: 1265404909
Provider Name (Legal Business Name): RICHARD ANDREW VANBERGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E MAIN ST
NEW IBERIA LA
70560-4031
US

IV. Provider business mailing address

600 JEFFERSON ST STE 301
LAFAYETTE LA
70501-6987
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-1048
  • Fax: 337-367-0131
Mailing address:
  • Phone: 337-470-2180
  • Fax: 337-470-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00021414
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number050849
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME85146
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10760R
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.10760R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: