Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 5168 | AK |
NPI | 1285627869 |
---|---|
Provider Name | Susan Bertrand |
First Address | Hunt Valley, MD 21031 |
Second Address | Cary, NC 27518-7091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 26/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0190956 | WA DEPT OF L&I (01) | AK |
D32653 | (02) | AK |
MD5212 | (05) | AK |