Individual
MR. DEANE BERGSRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4660 KENMORE AVE, SUITE 900, ALEXANDRIA, VA 22304-1313
(703) 212-0700
(703) 212-0705
Mailing address
4660 KENMORE AVE, SUITE 900, ALEXANDRIA, VA 22304-1313
(703) 212-0700
(703) 212-0705
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110000120
VA
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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