MEDICARE: KRISTIN BERGMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86027994	OH

General Provider Information

NPI Number	:	1629466180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BERGMAN

Provider Business Mailing Address
First Line	:	4819 PERLMAN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-9076
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4819 PERLMAN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-9076
Country	:	US
Telephone Number	:	937-441-8751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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Directions to “ KRISTIN BERGMAN ” Practice Location

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