MEDICARE: CARA BERGMAN L.AC., M.AC.

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	171100000X	Acupuncturist	U01367	MD

General Provider Information

NPI Number	:	1699921601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA BERGMAN L.AC., M.AC.

Provider Business Mailing Address
First Line	:	515 OWENS WAY
Second Line	:
City	:	SEVERNA PARK
State	:	MD
Zip	:	21146-3720
Country	:	US
Telephone Number	:	410-271-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 TIDEWATER COLONY WAY
Second Line	:	SUITE B2
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-2107
Country	:	US
Telephone Number	:	410-271-3935
Fax Number	:

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

Provider Enumeration Date	:	08/10/2008
Last Update Date	:	08/10/2008

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