DR. LAWRENCE RUSSELL BERGMAN M.D. NPI 1073518130

NPI Information

NPI: 1073518130
Provider Name: DR. LAWRENCE RUSSELL BERGMAN, M.D.
Classification: Pediatrics - 2080A0000X
Entity Type: Individual

Specialization: Adolescent Medicine

CLIA Number: 10D1065956

Address:
10115 W FOREST HILL BLVD
STE 303
WELLINGTON, FL
ZIP 33414
Phone: (561) 798-5565
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DR. Lawrence Russell Bergman, M.D. is an adolescent medicine pediatrics in Wellington, FL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. DR. Lawrence Russell Bergman, M.D. NPI is 1073518130. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

10115 W FOREST HILL BLVD
STE 303
WELLINGTON, FL
ZIP 33414-102
Phone: (561) 798-5565
Fax: (561) 798-9756

The CLIA number assigned to this NPI record is 10D1065956 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/16/2005 and was last updated on 9/21/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	ME56164	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003224800	MEDICAID	FLORIDA
2	E91787	MEDICARE UPIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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