Healthcare Provider Details

I. General information

NPI: 1124045208
Provider Name (Legal Business Name): TANIA FERNANDEZ BERTSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MAIN ST
ESSEX JCT VT
05452-3234
US

IV. Provider business mailing address

44 HILL RD
SOUTH HERO VT
05486-4112
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8354
  • Fax: 802-847-6575
Mailing address:
  • Phone: 802-372-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number420006953
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: