Healthcare Provider Details

I. General information

NPI: 1932302163
Provider Name (Legal Business Name): BERTRAM JOSEPH LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 SHERIDAN ST
PORT TOWNSEND WA
98368-2443
US

IV. Provider business mailing address

PO BOX 218
PORT TOWNSEND WA
98368-0218
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-2200
  • Fax:
Mailing address:
  • Phone: 360-385-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD00014877
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: