Healthcare Provider Details

I. General information

NPI: 1609865823
Provider Name (Legal Business Name): KENNETH R. BERTKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

IV. Provider business mailing address

2830 EASTON AVE
BETHLEHEM PA
18017-4204
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-3555
  • Fax: 484-526-3560
Mailing address:
  • Phone: 484-526-3555
  • Fax: 484-526-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35050904
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65395
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD460346
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: