Healthcare Provider Details

I. General information

NPI: 1740129147
Provider Name (Legal Business Name): JARED DOUGLAS BERGMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LOTHROP ST STE 214
PITTSBURGH PA
15213-2548
US

IV. Provider business mailing address

3600 FORBES AVE
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-6801
  • Fax:
Mailing address:
  • Phone: 412-624-3595
  • Fax: 412-648-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045780
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: