MEDICARE: DR. ABIGAIL BERTALAN VMD

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	174M00000X	Veterinarian	BV012483	PA

General Provider Information

NPI Number	:	1215367339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABIGAIL BERTALAN VMD

Provider Business Mailing Address
First Line	:	4029 WALNUT ST
Second Line	:	APT 6
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 DELANCEY ST
Second Line	:	2025 MJR-VHUP
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5052
Country	:	US
Telephone Number	:	215-746-7999
Fax Number	:

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

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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