Provider Demographics
NPI:1619045499
Name:VONZABERN, BERTRAM (MD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:
Last Name:VONZABERN
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 1:311 COLBURN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:NH
Mailing Address - Zip Code:03084
Mailing Address - Country:US
Mailing Address - Phone:603-878-2248
Mailing Address - Fax:603-878-2248
Practice Address - Street 1:311 COLBURN RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:NH
Practice Address - Zip Code:03084
Practice Address - Country:US
Practice Address - Phone:603-878-2248
Practice Address - Fax:603-878-2248
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80004131Medicaid
NH 4131Medicare ID - Type Unspecified
NH80004131Medicaid