Provider Demographics
NPI:1851432363
Name:BERTOCCHI, CRISTIANA M (MD)
Entity Type:Individual
Prefix:
First Name:CRISTIANA
Middle Name:M
Last Name:BERTOCCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE. 401
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5767
Mailing Address - Fax:207-795-5691
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE. 401
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5767
Practice Address - Fax:207-795-5691
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18217208600000X
PAMD423091208600000X
WAMD602082383208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000564803Medicare PIN
ME000564802Medicare PIN
MEE400122705Medicare PIN
PA102371403Medicaid
OH2999331Medicaid