Provider Demographics
NPI:1194744060
Name:BERGSAGEL, DANIEL JOHN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:BERGSAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3117
Mailing Address - Country:US
Mailing Address - Phone:404-785-1200
Mailing Address - Fax:404-592-6828
Practice Address - Street 1:2220 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3117
Practice Address - Country:US
Practice Address - Phone:404-785-1200
Practice Address - Fax:404-592-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA294072080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00463361AMedicaid
GA00463361AMedicaid