Basic Information
| Provider Information | |||||||||
| NPI: | 1760437420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | BERTRAND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327000 | ||||||||
| FaxNumber: | 3368327869 | ||||||||
| Practice Location | |||||||||
| Address1: | 1131-C NORTH CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368327867 | ||||||||
| FaxNumber: | 3368327869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 22107 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 22107 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31950 | 01 | NC | BCBS NC | OTHER | 4646468 | 01 | NC | AETNA | OTHER | 6813 | 01 | NC | PARTNERS MEDICARE CHOICE | OTHER | 23695 | 01 | NC | MEDCOST | OTHER | 8931950 | 05 | NC | MEDICAID |