Provider Demographics
NPI:1295590552
Name:BERTRAM, BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BERTRAM
Suffix:
Gender:M
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 1:156 YAMACRAW PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8839
Mailing Address - Country:US
Mailing Address - Phone:270-566-8389
Mailing Address - Fax:
Practice Address - Street 1:2108 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2502
Practice Address - Country:US
Practice Address - Phone:859-260-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical