Healthcare Provider Details

I. General information

NPI: 1144225525
Provider Name (Legal Business Name): SCOT F. BERTOLO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 N HIGH ST
COLUMBUS OH
43214-2637
US

IV. Provider business mailing address

4485 N HIGH ST
COLUMBUS OH
43214-2637
US

V. Phone/Fax

Practice location:
  • Phone: 614-824-5336
  • Fax: 614-732-4990
Mailing address:
  • Phone: 614-824-5336
  • Fax: 614-732-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.003201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: