Provider Demographics
NPI:1639602402
Name:BERGMEYER, MARIE LUISE (DO)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LUISE
Last Name:BERGMEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9055 CHEVROLET DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4000
Mailing Address - Country:US
Mailing Address - Phone:410-750-9200
Mailing Address - Fax:410-750-9211
Practice Address - Street 1:9055 CHEVROLET DR STE 203
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4000
Practice Address - Country:US
Practice Address - Phone:410-750-9200
Practice Address - Fax:410-750-9211
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDH0087699208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice