Provider Demographics
NPI:1053572578
Name:BERSETH, CAROL LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:BERSETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-3632
Mailing Address - Country:US
Mailing Address - Phone:812-471-8984
Mailing Address - Fax:
Practice Address - Street 1:401 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-3632
Practice Address - Country:US
Practice Address - Phone:812-471-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056952A2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND82126Medicare UPIN