Healthcare Provider Details

I. General information

NPI: 1013909993
Provider Name (Legal Business Name): HELAINE FANNIE BERTSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

53 DEER RUN
AVON CT
06001-3147
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-5702
  • Fax: 860-545-1500
Mailing address:
  • Phone: 860-545-5702
  • Fax: 860-545-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: