Provider Demographics
NPI:1699717439
Name:BERGMANN, CHRISTOPH ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPH
Middle Name:ALEXANDER
Last Name:BERGMANN
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 1:4934 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-8715
Mailing Address - Country:US
Mailing Address - Phone:662-840-1708
Mailing Address - Fax:
Practice Address - Street 1:4934 PECAN DR
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-8715
Practice Address - Country:US
Practice Address - Phone:662-840-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS162892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120594Medicaid
AL009908720Medicaid
MS300096927OtherRAILROAD MEDICARE
AL009908720Medicaid
AL051557196Medicare PIN
MS00120594Medicaid
MS300096927OtherRAILROAD MEDICARE