Kenneth R Bergman Jr., MD
Individual provider Active NPI Sleep Medicine (Otolaryngology) Physician · Elkton, VA
NPI 1659349447 · NPPES record last updated Jan 2, 2025
Key facts
- NPI
- 1659349447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sleep Medicine (Otolaryngology) Physician 207YS0012X
- License
- 0101102580 (VA)
- Practice address
- 4116 Brown Mountain LN
Elkton, VA 22827-3409 - Phone
- (571) 246-7223
- NPI assigned
- Mar 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070626000440 | VA | Practitioner - Otolaryngology | 1254430630 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101102580 | VA | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loudoun Medical Group, PC | Otolaryngology | Current |
Accepting new patients |
Locations
6355 Walker Ln
Ste 308
Alexandria, VA 22310
Phone (703) 313-7700
20955 Professional Plz
Ste 200
Ashburn, VA 20147
Phone (703) 729-7652
14535 John Marshall Hwy
Ste 212
Gainesville, VA 20155
Phone (571) 248-0245
44055 Riverside Pkwy
#20811302
Leesburg, VA 20176
Phone (703) 729-7652
1860 Town Center Dr
Ste 225
Reston, VA 20190
Phone (703) 483-3610
Interoperability endpoints
- kenneth.bergman@lmg1.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sleep Medicine (Otolaryngology) Physician | 207YS0012X | 0101102580 | VA | Yes |
| Otolaryngology Physician | 207Y00000X | 0101102580 | VA |
Addresses
Primary practice location
4116 Brown Mountain LN
Elkton, VA 22827-3409
Mailing address
4116 Brown Mountain LN
Elkton, VA 22827-3409
Phone (571) 246-7223
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00406443 | Other | VA | RR MEDICARE |
Other providers in Elkton, VA
- Gillian Aiello
- May A.C. Anderson
- Kate A Bowman
- Angela K Brittle
- Erin Burke
- Andrew T Cecil
- Corry Allen Chapman
All providers in Elkton, VA · Sleep Medicine (Otolaryngology) Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.