=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457568354
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA J BERTUCCI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8765 STENTON AVENUE
-----------------------------------------------------
City | WYNDMOOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-8317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-836-2440
-----------------------------------------------------
Fax | 215-836-2448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8765 STENTON AVENUE
-----------------------------------------------------
City | WYNDMOOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-8317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-836-2440
-----------------------------------------------------
Fax | 215-836-2448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | MD430331
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------