MEDICARE: DEBORAH R BERGEN MD

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	2084P0800X	Psychiatry Physician	0426158	KS
2	2084P0800X	Psychiatry Physician	27292	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912985128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH R BERGEN MD

Provider Business Mailing Address
First Line	:	6 HOSPITAL PLZ
Second Line	:
City	:	CLARKSBURG
State	:	WV
Zip	:	26301-9316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 COMMERCE DR
Second Line	:	STE B
City	:	WESTOVER
State	:	WV
Zip	:	26501-3952
Country	:	US
Telephone Number	:	304-241-1708
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/20/2017

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Directions to “ DEBORAH R BERGEN MD” Practice Location

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