Provider Demographics
NPI:1477601235
Name:BERTOLI, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BERTOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 MYRTLE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2700
Mailing Address - Country:US
Mailing Address - Phone:814-452-5400
Mailing Address - Fax:865-305-8873
Practice Address - Street 1:2508 MYRTLE ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2700
Practice Address - Country:US
Practice Address - Phone:814-452-5400
Practice Address - Fax:814-454-2003
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN282792085R0203X
TN245902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077791Medicaid
TN3077792Medicare ID - Type Unspecified
TN3077791Medicaid