DR. KENNETH R BERGMAN JR. (NPI# 1659349447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659349447 |
| Entity Type | Individual |
| Full Name | DR. KENNETH R BERGMAN JR. |
| Credential | MD |
| Practice Address |
14631 Lee Hwy Ste 413 Centreville VA 20121-5824 |
| Practice Telephone | 7033858222 |
| Practice Fax Number | 7038328809 |
| Mailing Telephone | 7033858222 |
| Mailing Fax Number | 7038328809 |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 0101102580 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RR MEDICARE | P00406443 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013912252 | Kenneth Robert Bergman | Allergy & Immunology | 13890 Braddock Rd, Ste 206, Centreville, VA 20121-2437 | 2005-06-15 |
| 1669443032 | Kenneth S Bergman | Radiology | 11511 Canterwood Blvd Nw, Suite 50, Gig Harbor, WA 98332-5813 | 2006-02-01 |
| Street Address |
14631 LEE HWY STE 413 |
| City | CENTREVILLE |
| State | VA |
| Zip Code | 20121-5824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669449435 | Kanwal S Khan | Obstetrics & Gynecology | 14631 Lee Hwy, Suite 405, Centreville, VA 20121-5824 | 2006-03-01 |
| 1336697051 | All Female Ob/gyn | Clinic/Center | 14631 Lee Hwy, #405, Centreville, VA 20121-5824 | 2016-09-12 |
| 1093166308 | Teresa Cralle | Registered Nurse | 14631 Lee Hwy, #413, Centreville, VA 20121-5824 | 2016-06-28 |
| 1255682654 | Center for Specialty Care, Plc | Physical Therapist | 14631 Lee Hwy, Suite 310, Centreville, VA 20121-5824 | 2012-09-25 |
| 1730465154 | Mohamad Bashar Ayass | Dentist | 14631 Lee Hwy, #301, Centreville, VA 20121 | 2011-10-31 |
| 1366735235 | V Care Dental | Dentist | 14631 Lee Hwy, 117, Centreville, VA 20121-5824 | 2011-05-25 |
| 1710288840 | Kelly Smith | Physical Therapist | 14631 Lee Hwy, Suite 310, Centreville, VA 20121-5824 | 2010-11-05 |
| 1144543018 | Loudoun Medical Group PC | Otolaryngology | 14631 Lee Hwy, Suite 405, Centreville, VA 20121-5824 | 2010-03-08 |
| 1972774024 | Ira Clifford Newman | Psychiatry & Neurology | 14631 Lee Hwy, Suite #207, Centreville, VA 20121-5824 | 2008-03-17 |
| 1043413008 | Carol Govoni | Physical Therapist | 14631 Lee Hwy, Suite 310, Centreville, VA 20121-2112 | 2007-06-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356906994 | Everyone Inc. | Durable Medical Equipment & Medical Supplies | 6362 James Harris Way, Centreville, VA 20121 | 2019-05-09 |
| 1154845139 | Dien Tu | Pharmacist | 6321 Powder Flask Ct., Centreville, VA 20121 | 2017-08-01 |
| 1053865337 | Chungkang Pharmacy, LLC | Pharmacy | 14637 Lee Highway, #109b, Centreville, VA 20121 | 2016-08-04 |
| 1265829808 | Trisha Yamamoto | Chiropractor | 14215 E. Centreville Square, Centreville, VA 20121 | 2015-04-21 |
| 1811305733 | Catherine Elizabeth Sims, LLC | Clinic/Center | 6705 Bay Valley Lane, Centreville, VA 20121 | 2014-07-23 |
| 1194138438 | All In A Day Senior Care Services.com | Home Health | 6913 Confederate Ridge Lane, Centerville, VA 20121 | 2014-06-04 |
| 1447519483 | James Hamilton | Occupational Therapy Assistant | 6220 William Mosby Dr, Centreville, VA 20121 | 2012-05-11 |
| 1609158674 | Rena Thuman | Dentist | 14245-f Centreville Square, Centreville, VA 20121 | 2011-09-15 |
| 1134426372 | One Stop Pharmacy Inc | Pharmacy | 13818-b Braddock Rd, Centreville, VA 20121 | 2011-02-24 |
| 1225267495 | Michael Andrew Hartman | Family Medicine | 6201 Centerville Rd, # 100, Centreville, VA 20121 | 2009-07-09 |
| Find all providers in zip 20121 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144543018 | Loudoun Medical Group PC | Otolaryngology | 14631 Lee Hwy, Suite 405, Centreville, VA 20121-5824 | 2010-03-08 |
| 1629238597 | Loudoun Medical Group PC | Otolaryngology | 5895 Trinity Pkwy, Suite 100, Centreville, VA 20120-1995 | 2008-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174005417 | Roanoke Valley Ent & Allergy PC | Otolaryngology | 2154 Mcvitty Rd, Second Floor, Roanoke, VA 24018 | 2018-09-04 |
| 1629459243 | Kevin James Quinn | Otolaryngology | 1200 E Broad St # 980257, Richmond, VA 23298 | 2015-06-10 |
| 1356778641 | Stat, LLC | Otolaryngology | 10812 Weather Vane Rd, Richmond, VA 23238-4161 | 2013-10-01 |
| 1134564073 | Ear, Nose, Throat & Allergy Consultants, PC | Otolaryngology | 26208 Lee Highway, Abingdon, VA 24211-7504 | 2013-05-06 |
| 1467790477 | Marco Aurelio Merida | Otolaryngology | 7216 Farm Meadow Ct, Mc Lean, VA 22101-5657 | 2013-01-25 |
| 1609142355 | Neelima Tummala | Otolaryngology | 1860 Town Center Dr Ste 420, Reston, VA 20190-5901 | 2012-03-27 |
| 1346512225 | John Laurence Manwaring | Otolaryngology | 7734 Retreat Ln, Warrenton, VA 20186-7546 | 2012-02-07 |
| 1508151887 | Jose Luis Mattos | Otolaryngology | 415 Ray C. Hunt Dr Ste 2200, Charlottesville, VA 22903-0001 | 2011-06-14 |
| 1982998852 | Blue Ridge Medical Management Corporation | Otolaryngology | 7021 W Lee Highway, Suite B, Rural Retreat, VA 24368-0000 | 2011-06-08 |
| 1609168327 | Jae Y Kim | Otolaryngology | 2200 Wilson Blvd Ste 102-219, Arlington, VA 22201-3397 | 2011-05-12 |
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| City | CENTREVILLE |
| Zip Code | 20121 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.