Basic Information
| Provider Information | |||||||||
| NPI: | 1124045208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTSCH | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | FERNANDEZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44 HILL RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH HERO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054864112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023725873 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 87 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ESSEX JCT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054523234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028478354 | ||||||||
| FaxNumber: | 8028476575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 420006953 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0005974 | 05 | VT | MEDICAID | 42-0006953 | 01 | VT | STATE LICENSE | OTHER | AB2302507 | 01 | VT | DEA CERTIFICATION | OTHER |