Healthcare Provider Details

I. General information

NPI: 1770588519
Provider Name (Legal Business Name): SALVATORE J. BERTOLONE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E GRAY ST STE 601
LOUISVILLE KY
40202-3902
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-3600
  • Fax: 502-588-9536
Mailing address:
  • Phone: 502-588-3600
  • Fax: 502-588-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number15837
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: