Provider Demographics
NPI:1497745525
Name:KERSBERGEN, DAVID JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:KERSBERGEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8500
Mailing Address - Fax:910-907-9630
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8500
Practice Address - Fax:910-907-9630
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102050143207Q00000X
IA04583207Q00000X
NC2017-00394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine