Individual
DR. ETHAN SCHUYLER BERGVALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1240 LEE ST, CHARLOTTESVILLE, VA 22908-0817
(434) 924-9333
(434) 243-3938
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
(434) 295-1000
(434) 972-4266
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
0101268271
VA
Other
Enumeration date
08/20/2007
Last updated
08/08/2023
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