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General NPI Number Information
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NPI Number | 1235304312
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Entity Type | Organization
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Legal Business Name | BERGMAN EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 220 CHAMPION DR SUITE 101
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City | HAGERSTOWN
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State | MD
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Zip | 21740-6558
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Country | US
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Telephone | 301-791-0888
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Fax | 301-791-3611
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Provider Business Mailing Address
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Address Line | 220 CHAMPION DR SUITE 100
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City | HAGERSTOWN
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State | MD
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Zip | 21740-6558
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Country | US
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Telephone | 301-791-0888
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Fax | 301-791-3611
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Authorized Official
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Title or Position | OWNER
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Name | AUGUSTUS GRAHAM STERN
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Credential | M.D.
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Telephone | 301-791-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | MDPSCASC
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License Number State | MD
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