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General NPI Number Information
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NPI Number | 1336778646
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Entity Type | Individual
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Provider Name | ILANA BERGELSON
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Gender | Female
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 500 E MAIN ST STE 220
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City | COLUMBUS
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State | OH
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Zip | 43215-5369
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Country | US
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Telephone | 614-544-9670
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Fax | 614-544-9671
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Provider Business Mailing Address
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Address Line | PO BOX 7527
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City | DUBLIN
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State | OH
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Zip | 43017-0727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | R-11942
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35.154225
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License Number State | OH
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