Basic Information
Provider Information
NPI: 1720131048
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERGSMAN
FirstName: AARON
MiddleName: ELI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 33369
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282333369
CountryCode: US
TelephoneNumber: 7043648100
FaxNumber: 7043652073
Practice Location
Address1: 10030 GILEAD RD
Address2: STE. 300
City: HUNTERSVILLE
State: NC
PostalCode: 280787545
CountryCode: US
TelephoneNumber: 7048959390
FaxNumber: 7048957760
Other Information
ProviderEnumerationDate: 01/19/2007
LastUpdateDate: 02/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X11-00708NCY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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