Provider Demographics
NPI:1467435024
Name:BERTRAM, ROBERT ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALVIN
Last Name:BERTRAM
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-633-9441
Mailing Address - Fax:
Practice Address - Street 1:911 W HENDERSON ST
Practice Address - Street 2:STE 110
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2736
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:704-637-9006
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26797208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8915251Medicaid
NCNCP231AMedicare PIN
NCC82811Medicare UPIN
NC8915251Medicaid