Provider Demographics
NPI:1740233691
Name:BARTHOLOMEW, ALBERT D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:D
Last Name:BARTHOLOMEW
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 487
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33826-0487
Mailing Address - Country:US
Mailing Address - Phone:863-453-7545
Mailing Address - Fax:
Practice Address - Street 1:1210 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7948
Practice Address - Country:US
Practice Address - Phone:863-402-3372
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71898207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17535Medicare UPIN