Provider Demographics
NPI:1932702206
Name:BERTUCCI, CAITLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BERTUCCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 BUNKER HILL DR N
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-8818
Mailing Address - Country:US
Mailing Address - Phone:908-202-9600
Mailing Address - Fax:
Practice Address - Street 1:401 N 17TH ST STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5051
Practice Address - Country:US
Practice Address - Phone:610-969-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant