Active NPI
Mary E. Bergman, PA-C
- Physician Assistant
- Fort Lee, VA
National Provider Identifier
1497059729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110003446
- Practice address
- Kenner Army Health Clinic
700 24TH St
Fort Lee, VA 23801 - Phone
- (804) 734-9491
- NPI assigned
- Dec 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110003446 | VA | Primary |
Addresses
Primary practice location
Kenner Army Health Clinic
700 24TH St
Fort Lee, VA 23801
Mailing address
Kenner Army Health Clinic
700 24TH St
Fort Lee, VA 23801
Phone (804) 734-9491
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110003446 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1497059729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "KENNER ARMY HEALTH CLINIC",
"address_2": "700 24TH ST",
"city": "FORT LEE",
"state": "VA",
"postal_code": "23801",
"telephone_number": "804-734-9491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "KENNER ARMY HEALTH CLINIC",
"address_2": "700 24TH ST",
"city": "FORT LEE",
"state": "VA",
"postal_code": "23801",
"telephone_number": "804-734-9491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "MARY",
"middle_name": "E.",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-30",
"last_updated": "2023-03-07",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110003446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.