Provider Demographics
NPI:1710991880
Name:SCHLAM, BERTRAND WAX (M D)
Entity Type:Individual
Prefix:
First Name:BERTRAND
Middle Name:WAX
Last Name:SCHLAM
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GREYFRIARS LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8642
Mailing Address - Country:US
Mailing Address - Phone:919-362-3949
Mailing Address - Fax:
Practice Address - Street 1:301 GREYFRIARS LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8642
Practice Address - Country:US
Practice Address - Phone:919-362-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0191552085R0202X
NC381972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974853Medicaid
SCN38197Medicaid
E09089Medicare UPIN
NC8974853Medicaid
SCAA19806685Medicare PIN