Healthcare Provider Details

I. General information

NPI: 1164091179
Provider Name (Legal Business Name): AARON BERTOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

6120 PASEO AL MAR BLVD APT 2141
APOLLO BEACH FL
33572-1697
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-2506
  • Fax: 813-974-5762
Mailing address:
  • Phone: 313-335-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberTRN39152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: