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General NPI Number Information
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NPI Number | 1871542902
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Entity Type | Individual
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Provider Name | SUZANNE M. BERTOLLO M.D., MPH
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 777 GLADES RD # BC71
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City | BOCA RATON
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State | FL
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Zip | 33431-6424
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Country | US
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Telephone | 561-297-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 777 GLADES RD # BC-71
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City | BOCA RATON
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State | FL
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Zip | 33431-6424
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Country | US
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Telephone | 561-297-3622
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME144621
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 9700023
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 30296
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | ME144621
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 30296
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License Number State | SC
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