Healthcare Provider Details

I. General information

NPI: 1609811033
Provider Name (Legal Business Name): SHERRY A. BERGLUND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W. BELVEDERE AVE
BALTIMORE MD
21215
US

IV. Provider business mailing address

2401 W. BELVEDERE AVE SINAI HOSPITAL ADDICTIONS RECOVERY PROGRAM
BALTIMORE MD
21215
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-9811
  • Fax:
Mailing address:
  • Phone: 410-323-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001948
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberC0001948
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC0001948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: