Individual provider Active NPI

Marie Luise Bergmeyer, DO

  • General Practice Physician
  • Ellicott City, MD
National Provider Identifier
1639602402
Registry record updated Jul 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
H0087699 Issued in MD
Practice address
9055 Chevrolet Dr Ste 203
Ellicott City, MD 21042-4000
Phone
(410) 750-9200
Fax
(410) 750-9211
NPI assigned
Apr 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X H0087699 MD Primary

Addresses

Primary practice location

9055 Chevrolet Dr Ste 203
Ellicott City, MD 21042-4000

Mailing address

9055 Chevrolet Dr Ste 203
Ellicott City, MD 21042-4000
Phone (410) 750-9200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
H0087699MDMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1491523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753574400000",
    "number": "1639602402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9055 CHEVROLET DR STE 203",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424000",
            "telephone_number": "410-750-9200",
            "fax_number": "410-750-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9055 CHEVROLET DR STE 203",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210424000",
            "telephone_number": "410-750-9200",
            "fax_number": "410-750-9211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMEYER",
        "first_name": "MARIE",
        "middle_name": "LUISE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-07",
        "last_updated": "2025-07-27",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MD",
            "license": "H0087699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.