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General NPI Number Information
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NPI Number | 1922295278
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Entity Type | Organization
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Legal Business Name | BERTA M BERGIA MD PC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 9333 PARK WEST BLVD #108
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City | KNOXVILLE
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State | TN
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Zip | 37923-4305
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Country | US
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Telephone | 865-531-6161
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Fax | 865-691-3691
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Provider Business Mailing Address
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Address Line | 9333 PARK WEST BLVD #108
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City | KNOXVILLE
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State | TN
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Zip | 37923-4305
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Country | US
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Telephone | 865-531-6161
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Fax | 865-691-3691
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Authorized Official
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Title or Position | MD PHYSICIAN NEUROLOGY
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Name | DR. BERTA M BERGIA
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Credential | MD
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Telephone | 865-531-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 17849
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License Number State | TN
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