1164655502 NPI number — ANDREA C BERTORELLI CPNP

Table of content: ANDREA C BERTORELLI CPNP (NPI 1164655502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164655502 NPI number — ANDREA C BERTORELLI CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTORELLI
Provider First Name:
ANDREA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164655502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
490 BOSTON POST RD
Provider Second Line Business Mailing Address:
MILLBROOK PEDIATRICS, SUITE 2002
Provider Business Mailing Address City Name:
SUDBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-443-0707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SUITE 2002
Provider Business Practice Location Address City Name:
SUDBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-443-0707
Provider Business Practice Location Address Fax Number:
978-440-9389
Provider Enumeration Date:
09/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  263463 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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