Provider Demographics
NPI:1730116518
Name:BERGMAN, DEBRA C (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:C
Last Name:BERGMAN
Suffix:
Gender:F
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:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-802-3158
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:12425 OLD MERIDIAN ST
Practice Address - Street 2:SUITE #B1
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8724
Practice Address - Country:US
Practice Address - Phone:317-581-0001
Practice Address - Fax:317-581-0002
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045277A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN239560BMedicare PIN
IN278000EMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
INH92052Medicare UPIN