Healthcare Provider Details

I. General information

NPI: 1285627869
Provider Name (Legal Business Name): SUSAN BERTRAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 KEISLER DR STE 101
CARY NC
27518-7091
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 919-803-0813
  • Fax:
Mailing address:
  • Phone: 703-914-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number5168
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5168
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: