MEDICARE: ELENA BERTOLINO

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	363LP0222X	Critical Care Pediatric Nurse Practitioner	R113854	MD

General Provider Information

NPI Number	:	1285051896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA BERTOLINO

Provider Business Mailing Address
First Line	:	12 WHIPPOORWILL RD
Second Line	:
City	:	RYE BROOK
State	:	NY
Zip	:	10573-1027
Country	:	US
Telephone Number	:	202-365-3837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 ORLEANS ST STE 6320
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21287-4904
Country	:	US
Telephone Number	:	410-955-7610
Fax Number	:

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

Provider Enumeration Date	:	03/20/2014
Last Update Date	:	03/20/2014

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Directions to “ ELENA BERTOLINO ” Practice Location

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