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NPI Code Detail

MEDICARE: SAMUEL T BERTSOS PA

MEDICARE: SAMUEL T BERTSOS PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant50.007614RXOH

General Provider Information

NPI Number : 1114668928
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL T BERTSOS PA
Provider Business Mailing Address
First Line : 6480 HARRISON AVE STE 201
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7961
Country : US
Telephone Number : 513-354-3700
Fax Number :
Provider Business Practice Location Address
First Line : 2835 MIAMI VILLAGE DR
Second Line :
City : MIAMISBURG
State : OH
Zip : 45342-4916
Country : US
Telephone Number : 937-354-3700
Fax Number : 937-262-7468
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 06/15/2022

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Directions to “ SAMUEL T BERTSOS PA” Practice Location

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