Family Allergy Center,P.C.

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

0101025702 Issued in VA

Legal business name

FAMILY ALLERGY CENTER,P.C.

Practice address

13890 Braddock Rd
Suite 206
Centreville, VA 20121-2435

Phone

(703) 263-2333

Fax

(703) 263-0361

NPI assigned

May 30, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Robert Bergman, M.D.

Title

President

Phone

(703) 263-2333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891996658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD",
            "address_2": "SUITE 206",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212435",
            "telephone_number": "703-263-2333",
            "fax_number": "703-263-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13890 BRADDOCK RD",
            "address_2": "SUITE 206",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201212435",
            "telephone_number": "703-263-2333",
            "fax_number": "703-263-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY ALLERGY CENTER,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-263-2333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "VA",
            "license": "0101025702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.