MEDICARE: DR. CARL ANDREW BERTELSEN 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
1	208600000X	Surgery Physician	G44277	CA

General Provider Information

NPI Number	:	1205978806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL ANDREW BERTELSEN MD

Provider Business Mailing Address
First Line	:	2450 SAMARITAN DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3912
Country	:	US
Telephone Number	:	408-358-1855
Fax Number	:	408-356-4183

Provider Business Practice Location Address
First Line	:	2450 SAMARITAN DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3912
Country	:	US
Telephone Number	:	408-358-1855
Fax Number	:	408-356-4183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	09/27/2013

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