Provider Demographics
NPI:1699921601
Name:BERGMAN, CARA (LAC, MAC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 OWENS WAY
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3720
Mailing Address - Country:US
Mailing Address - Phone:410-271-3935
Mailing Address - Fax:
Practice Address - Street 1:2009 TIDEWATER COLONY WAY
Practice Address - Street 2:SUITE B2
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2107
Practice Address - Country:US
Practice Address - Phone:410-271-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist