MEDICARE: DR. KENNETH ALVIN BERTRAM MD

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
1	207RH0003X	Hematology & Oncology Physician	MD00024580	WA

General Provider Information

NPI Number	:	1336227628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ALVIN BERTRAM MD

Provider Business Mailing Address
First Line	:	6704 HEIRLOOM CT
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-5802
Country	:	US
Telephone Number	:	301-631-9228
Fax Number	:	301-319-9849

Provider Business Practice Location Address
First Line	:	1434 PORTER ST
Second Line	:	BARQUIST ARMY HEALTH CLINIC
City	:	FREDERICK
State	:	MD
Zip	:	21702-9210
Country	:	US
Telephone Number	:	301-619-4666
Fax Number	:	301-619-7676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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