Provider Demographics
NPI:1285759696
Name:BERGMANN, LEIGH S (MD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:S
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING ONE SUITE 300
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-6580
Mailing Address - Fax:610-525-3664
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING ONE SUITE 300
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-6580
Practice Address - Fax:610-525-3664
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061318L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA906434LLYMedicare ID - Type UnspecifiedMEDICARE INDIV. ID NUMBER
PAG48399Medicare UPIN