Dr Charles Kenneth Bergdolt, DO is a
Preventive Medicine - Aerospace Medicine physician based in Fallon, Nevada. Dr Charles Kenneth Bergdolt is licensed to practice in Idaho (license number O-1734) and his current practice location is 4755 Pasture Rd, Fallon, Nevada. He can be reached at his office (for appointments etc.) via phone at
(904) 542-7300.
NPI number for Dr Charles Kenneth Bergdolt is 1194392241 and his current mailing address is 4755 Pasture Rd, Fallon, Nevada. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1194392241.
Physician's Profile
| Full Name | Dr Charles Kenneth Bergdolt |
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| Gender | Male |
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| Speciality | Preventive Medicine - Aerospace Medicine |
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| Location | 4755 Pasture Rd, Fallon, Nevada |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1194392241
- Provider Enumeration Date: 06/08/2021
- Last Update Date: 07/10/2023
Medical Identifiers
Medical identifiers for Dr Charles Kenneth Bergdolt such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194392241 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 8288488 (Alabama) | Secondary |
| 2083A0100X | Preventive Medicine - Aerospace Medicine | O-1734 (Idaho) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Charles Kenneth Bergdolt is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Charles Kenneth Bergdolt, DO
4755 Pasture Rd,
Fallon, NV 89406-3491
Ph: (334) 224-8053 | Dr Charles Kenneth Bergdolt, DO
4755 Pasture Rd,
Fallon, NV 89406-3491
Ph: (904) 542-7300 |
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