Provider Demographics
NPI:1285606095
Name:BAGATELL BERG, ROCHELLE (MD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:BAGATELL BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:BAGATELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:CHCA HEMATOLOGY & ONCOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHCA HEMATOLOGY & ONCOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3535
Practice Address - Fax:215-590-3992
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259142080P0207X
PAMD4351342080P0207X
NY2828152080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ456500Medicaid
PA102208469Medicaid
AZ370013112OtherRR MEDICARE
AZZWCGCROtherGROUP MEDICARE PIN
PA102208469Medicaid
AZZ26439Medicare PIN