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General NPI Number Information
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NPI Number | 1336227628
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Entity Type | Individual
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Provider Name | KENNETH ALVIN BERTRAM MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1434 PORTER ST BARQUIST ARMY HEALTH CLINIC
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City | FREDERICK
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State | MD
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Zip | 21702-9210
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Country | US
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Telephone | 301-619-4666
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Fax | 301-619-7676
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Provider Business Mailing Address
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Address Line | 6704 HEIRLOOM CT
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City | FREDERICK
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State | MD
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Zip | 21702-5802
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Country | US
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Telephone | 301-631-9228
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Fax | 301-319-9849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD00024580
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License Number State | WA
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