Provider Demographics
NPI:1902980907
Name:BERGIN, EDWARD PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:PATRICK
Last Name:BERGIN
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 1:214 14TH AVE SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270
Mailing Address - Country:US
Mailing Address - Phone:406-488-2278
Mailing Address - Fax:406-488-2523
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:SUITE 105
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270
Practice Address - Country:US
Practice Address - Phone:406-488-2278
Practice Address - Fax:406-488-2523
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4475208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014220OtherBCBS
MT0058461Medicaid