Provider Demographics
NPI:1619119559
Name:BERTSCH, CAREY COMPTON (MD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:COMPTON
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:98 ELM ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2048
Practice Address - Country:US
Practice Address - Phone:812-496-8777
Practice Address - Fax:812-537-9974
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078512A208000000X
KY449682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100138790Medicaid
IN201070670Medicaid
KYK059150Medicare PIN