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Individual

DR. KENNETH R BERGMAN JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4116 BROWN MOUNTAIN LN, ELKTON, VA 22827-3409
(571) 246-7223
Mailing address
4116 BROWN MOUNTAIN LN, ELKTON, VA 22827-3409
(571) 246-7223

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0101102580
VA
207YS0012X
Sleep Medicine (Otolaryngology) Physician
Primary
0101102580
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00406443
RR MEDICARE
VA
Enumeration date
03/09/2006
Last updated
01/02/2025
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