Basic Information
| Provider Information | |||||||||
| NPI: | 1265443964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTSCH | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 PRYTANIA ST | ||||||||
| Address2: | SUITE 35 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048978315 | ||||||||
| FaxNumber: | 5048919862 | ||||||||
| Practice Location | |||||||||
| Address1: | 3434 PRYTANIA ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048977007 | ||||||||
| FaxNumber: | 5048977789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/29/2017 | ||||||||
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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 | MD023564 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1483087 | 05 | LA | MEDICAID |