Provider Demographics
NPI:1235494923
Name:PARCELLS, BERTRAND W (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAND
Middle Name:W
Last Name:PARCELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1620
Mailing Address - Country:US
Mailing Address - Phone:301-801-7097
Mailing Address - Fax:
Practice Address - Street 1:1200 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7631
Practice Address - Country:US
Practice Address - Phone:732-660-6200
Practice Address - Fax:732-660-6201
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
NJ25MA09815300207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty