Provider Demographics
NPI:1669684213
Name:BERTIN, PETER MARCEL (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARCEL
Last Name:BERTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-0384
Mailing Address - Country:US
Mailing Address - Phone:814-467-3637
Mailing Address - Fax:814-467-3622
Practice Address - Street 1:600 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1331
Practice Address - Country:US
Practice Address - Phone:814-467-4750
Practice Address - Fax:814-467-4751
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008273208600000X
PAOS015274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102495330Medicaid
PA102495330Medicaid