Provider Demographics
NPI:1093700676
Name:BERTRAND, DAVID SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 GUARDIAN AVE
Mailing Address - Street 2:STE E
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2975
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:3500 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2901
Practice Address - Country:US
Practice Address - Phone:252-247-2013
Practice Address - Fax:252-247-7299
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1274070001OtherDME MAC JURISDICTION C
1274070001OtherDME MAC JURISDICTION C
NCNC0955A417Medicare PIN