Provider Demographics
NPI:1487613444
Name:BERGERON, JOSEPH C (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:BERGERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2809
Mailing Address - Country:US
Mailing Address - Phone:781-292-7260
Mailing Address - Fax:781-292-7260
Practice Address - Street 1:152 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2809
Practice Address - Country:US
Practice Address - Phone:781-292-7260
Practice Address - Fax:781-292-7260
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38127207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0032285OtherNEIGHBORHOOD HEALTH PLAN
MA3053130Medicaid
MA6443277OtherCIGNA
MAAA10035OtherHARVARD PILGRIM
MA720679OtherTUFTS HEALTH PLAN
MAJ08619OtherBLUE CROSS
MAP00239489OtherMEDICARE RAILROAD
MA0032285OtherNEIGHBORHOOD HEALTH PLAN
MA720679OtherTUFTS HEALTH PLAN