Provider Demographics
NPI:1760437420
Name:FIELDS, KARL BERTRAND (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:BERTRAND
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:336-832-7869
Practice Address - Street 1:1131-C NORTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-832-7867
Practice Address - Fax:336-832-7869
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22107207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC31950OtherBCBS NC
NC4646468OtherAETNA
NC6813OtherPARTNERS MEDICARE CHOICE
NC23695OtherMEDCOST
NC8931950Medicaid
NC206270AMedicare ID - Type UnspecifiedMEDICARE
NC8931950Medicaid