Basic Information
| Provider Information | |||||||||
| NPI: | 1518064575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTRAND | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29343 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274299343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362720101 | ||||||||
| FaxNumber: | 3368093001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362720101 | ||||||||
| FaxNumber: | 3368093001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 20377 | NC | X | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 20377 | NC | X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8915260 | 05 | NC | MEDICAID |