Individual
SIMON BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7595
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7595
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
99-00765
NC
207ZP0101X
Anatomic Pathology Physician
Primary
99-00765
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1211X
BCBS
—
01
—
32153
PARTNERS
—
05
—
6605176
—
VA
01
—
7222325
AETNA
—
01
—
88713
MEDCOST
—
05
—
891211X
—
NC
05
—
9801025000
—
WV
05
—
Q00765
—
SC
Enumeration date
11/29/2005
Last updated
08/19/2010
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