MEDICARE: DR. KARL BERTRAND FIELDS M.D.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	22107	NC
2	207Q00000X	Family Medicine Physician	22107	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	6813	OTHER	NC	PARTNERS MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31950	OTHER	NC	BCBS NC
2	4646468	OTHER	NC	AETNA
4	23695	OTHER	NC	MEDCOST
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760437420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL BERTRAND FIELDS M.D.

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:	336-832-7000
Fax Number	:	336-832-7869

Provider Business Practice Location Address
First Line	:	1131-C NORTH CHURCH STREET
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1007
Country	:	US
Telephone Number	:	336-832-7867
Fax Number	:	336-832-7869

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/27/2021

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