Provider Demographics
NPI:1548664592
Name:BERGAMO, MOLLY ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ANN
Last Name:BERGAMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WEST 14TH STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1012
Mailing Address - Country:US
Mailing Address - Phone:215-344-1632
Mailing Address - Fax:
Practice Address - Street 1:501 WEST 14TH STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1012
Practice Address - Country:US
Practice Address - Phone:302-428-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN626519163W00000X
PASP014399363LF0000X
DELG-0000892363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily