Provider Demographics
NPI:1407336951
Name:BERTRAND, PHILIPPE B (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:B
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BOYLSTON ST # 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4143
Mailing Address - Country:US
Mailing Address - Phone:617-795-6253
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST DEPT OF
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-795-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program