Individual
LARRY RICHARD BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8800 N TRYON ST, CHARLOTTE, NC 28262-3300
(704) 863-5665
(704) 863-5848
Mailing address
PO BOX 560727, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28256-0727
(704) 863-5665
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
16268
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061405
RN LICENSE
NC
01
—
16268
AANA LICENSE
—
05
—
8050899
—
NC
Enumeration date
06/16/2006
Last updated
08/25/2007
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