Basic Information
| Provider Information | |||||||||
| NPI: | 1669684213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTIN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | MARCEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 384 | ||||||||
| Address2: | |||||||||
| City: | WINDBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159630384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144673637 | ||||||||
| FaxNumber: | 8144673622 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 SOMERSET AVE | ||||||||
| Address2: | |||||||||
| City: | WINDBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159631331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144674750 | ||||||||
| FaxNumber: | 8144674751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 12/15/2018 | ||||||||
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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 | 208600000X | 34.008273 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | OS015274 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 102495330 | 05 | PA | MEDICAID |