Healthcare Provider Details

I. General information

NPI: 1467407130
Provider Name (Legal Business Name): ROBERT L BERGREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OXFORD DR STE 300
MONROEVILLE PA
15146-2361
US

IV. Provider business mailing address

300 OXFORD DR STE 300
MONROEVILLE PA
15146-2361
US

V. Phone/Fax

Practice location:
  • Phone: 412-683-5300
  • Fax: 412-349-8655
Mailing address:
  • Phone: 412-683-5300
  • Fax: 412-349-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD041818E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012601760002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: