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NPI Code Detail

MEDICARE: MELANIE BERTENELLI MD

MEDICARE: MELANIE BERTENELLI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramPG178113OR
2207Q00000XFamily Medicine PhysicianMD189768OR

General Provider Information

NPI Number : 1013364728
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE BERTENELLI MD
Provider Business Mailing Address
First Line : 110 BEAVERCREEK RD STE 100
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-4307
Country : US
Telephone Number : 503-655-8471
Fax Number : 503-655-8595
Provider Business Practice Location Address
First Line : 37400 BELL ST
Second Line :
City : SANDY
State : OR
Zip : 97055-7868
Country : US
Telephone Number : 503-668-3483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2016
Last Update Date : 02/22/2021

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Directions to “ MELANIE BERTENELLI MD” Practice Location

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