Provider Demographics
NPI:1871605527
Name:BERGMAN, ELISABETH CALVO (MD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CALVO
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11676 PERRY HWY
Mailing Address - Street 2:STE 1308
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-933-0155
Mailing Address - Fax:724-933-0833
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 1308
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-933-0155
Practice Address - Fax:724-933-0833
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039333L207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
436083Medicare ID - Type Unspecified
C34131Medicare UPIN
PA436083X2NMedicare PIN