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General NPI Number Information
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NPI Number | 1134365620
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA INTERNAL MEDICINE & GERIATRICS PC
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 9503 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3034
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Country | US
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Telephone | 215-637-0102
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Fax | 215-281-0464
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Provider Business Mailing Address
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Address Line | 9501 HILSPACH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3918
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Country | US
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Telephone | 215-637-0102
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Fax | 215-281-0464
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HERBERT M BERGMAN
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Credential | M.D
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Telephone | 215-637-0102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD012582E
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License Number State | PA
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