Provider Demographics
NPI:1902892987
Name:BERGMAN, MELANIE KIM (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:KIM
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KIM
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-2200
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE STE 1400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-2200
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041339207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161207OtherLABOR & INDUSTRIES
7711025OtherAETNA
000010139925OtherBLUE SHIELD OF IDAHO
WA8095SNOtherASURIS NW HEALTH
KS038OtherBLUE CROSS OF IDAHO
WA8316663Medicaid
980000404OtherRAILROAD MEDICARE
ID806372200Medicaid
WA8095SNOtherASURIS NW HEALTH
980000404OtherRAILROAD MEDICARE