Provider Demographics
NPI:1326039579
Name:BERTELE, TERENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:BERTELE
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 1:12070 OLD LINE CTR
Mailing Address - Street 2:STE 303
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2513
Mailing Address - Country:US
Mailing Address - Phone:301-645-5100
Mailing Address - Fax:301-645-3695
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:STE 303
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-645-5100
Practice Address - Fax:301-645-3695
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030041207RC0000X
DCMD12286207RC0000X
VA101031774207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410942-01OtherBCBS
MD491041900Medicaid
MDKP06KS78Medicare ID - Type Unspecified
MD491041900Medicaid