MEDICARE: STANLEY BERTMAN, M.D., INC

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	207R00000X	Internal Medicine Physician	38273	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407885619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY BERTMAN, M.D., INC

Provider Business Mailing Address
First Line	:	3030 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4167
Country	:	US
Telephone Number	:	330-452-4455
Fax Number	:	330-452-1459

Provider Business Practice Location Address
First Line	:	3030 TUSCARAWAS ST W
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-4167
Country	:	US
Telephone Number	:	330-452-4455
Fax Number	:	330-452-1459

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STANLEY BERTMAN
Credential	:	M.D.
Telephone Number	:	330-452-4455

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	04/20/2008

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