Healthcare Provider Details

I. General information

NPI: 1114134327
Provider Name (Legal Business Name): CECILIA BERGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13551 WATERFORD PL
MIDLOTHIAN VA
23112-3929
US

IV. Provider business mailing address

1000 BOULDERS PKWY STE 102
NORTH CHESTERFIELD VA
23225-5515
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-4243
  • Fax: 804-622-0552
Mailing address:
  • Phone: 804-320-4243
  • Fax: 804-622-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number0101245255
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101245255
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101245255
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: