Provider Demographics
NPI:1578504551
Name:BERTIN, VINCENT J (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:BERTIN
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 1:18660 BAGLEY RD
Mailing Address - Street 2:PHASE II, SUITE 201
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3480
Mailing Address - Country:US
Mailing Address - Phone:440-243-0100
Mailing Address - Fax:440-243-7118
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:PHASE II, SUITE 201
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3480
Practice Address - Country:US
Practice Address - Phone:440-243-0100
Practice Address - Fax:440-243-7118
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0455242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0549893Medicaid
OH9933811Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
OHA80835Medicare UPIN