Individual provider Active NPI

Daniel Bergholz, MD

  • Student in an Organized Health Care Education/Training Program
  • New Haven, CT
National Provider Identifier
1366954349
Registry record updated Jul 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
20 York St
New Haven, CT 06510-3220
Phone
(203) 688-9503
NPI assigned
Oct 30, 2017
Last updated
Jul 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary
Behavior Technician 106S00000X RBT-17-42553 CO

Addresses

Primary practice location

20 York St
New Haven, CT 06510-3220

Mailing address

20 York St
New Haven, CT 06510-3220
Phone (203) 688-9503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260616000957 CT Order and Referring Only - Addiction MedicinePractitioner - Internal MedicinePractitioner - Addiction Medicine 6204308745

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
RBT-17-42553COMDBehavior Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783728000000",
    "number": "1366954349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-9503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGHOLZ",
        "first_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-30",
        "last_updated": "2026-07-11",
        "certification_date": "2026-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CO",
            "license": "RBT-17-42553",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.