Provider Demographics
NPI:1043214687
Name:BARTLE, BRYAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:BARTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3200
Mailing Address - Fax:336-832-3201
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-832-3200
Practice Address - Fax:336-832-3201
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400714208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1801562OtherUNITED HEALTHCARE
NC13590OtherBLUE CROSS & BLUE SHIELD
NC51171OtherMEDCOST
NC7913590Medicaid
NC330003708OtherRAILROAD MCR
NC2198433Medicare PIN
NC13590OtherBLUE CROSS & BLUE SHIELD