Provider Demographics
NPI:1790727568
Name:RESTA, BARTHOLOMEW J (MD)
Entity Type:Individual
Prefix:
First Name:BARTHOLOMEW
Middle Name:J
Last Name:RESTA
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 569
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0569
Mailing Address - Country:US
Mailing Address - Phone:252-482-7407
Mailing Address - Fax:252-482-5529
Practice Address - Street 1:203 EARNHART DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-8401
Practice Address - Country:US
Practice Address - Phone:252-482-7407
Practice Address - Fax:252-482-5529
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00339208000000X
TNMD0000020791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053045Medicaid
NC5909511Medicaid
NC148TAOtherBCBS
NC5909511Medicaid