Healthcare Provider Details

I. General information

NPI: 1275501728
Provider Name (Legal Business Name): BERTA M BERGIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BERTA M BERGIA-CHAO M.D.

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9352 PARK WEST BLVD
KNOXVILLE TN
37923-4325
US

IV. Provider business mailing address

DEPT 888217
KNOXVILLE TN
37995-8217
US

V. Phone/Fax

Practice location:
  • Phone: 865-373-1974
  • Fax: 865-373-1059
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number17849
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number17849
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: