Provider Demographics
NPI:1427797190
Name:BERSANI, VIRGINIA (DO)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:BERSANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:STODDARD-MERRIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5265 ROCKROSE LN BLDG J25
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-8264
Mailing Address - Country:US
Mailing Address - Phone:413-449-4209
Mailing Address - Fax:
Practice Address - Street 1:1200 S. CEDAR CREST BVLD
Practice Address - Street 2:6TH FLOOR JAINDL
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-402-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT021672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics