Provider Demographics
NPI:1336227628
Name:BERTRAM, KENNETH ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALVIN
Last Name:BERTRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6704 HEIRLOOM CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5802
Mailing Address - Country:US
Mailing Address - Phone:301-631-9228
Mailing Address - Fax:301-319-9849
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:BARQUIST ARMY HEALTH CLINIC
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9210
Practice Address - Country:US
Practice Address - Phone:301-619-4666
Practice Address - Fax:301-619-7676
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024580207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology