Provider Demographics
NPI:1184620056
Name:BERTSCH, MARY JO (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JO
Last Name:BERTSCH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2090 W ARLINGTON BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5727
Mailing Address - Country:US
Mailing Address - Phone:252-758-3000
Mailing Address - Fax:252-758-7107
Practice Address - Street 1:2090 W ARLINGTON BLVD
Practice Address - Street 2:STE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5727
Practice Address - Country:US
Practice Address - Phone:252-758-3000
Practice Address - Fax:252-758-7107
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-03-16
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Provider Licenses
StateLicense IDTaxonomies
NC9801170207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891230GMedicaid
NCC44641Medicare UPIN
NC891230GMedicaid