Provider Demographics
NPI:1932371242
Name:THOMAS F ERTLE DPM
Entity Type:Organization
Organization Name:THOMAS F ERTLE DPM
Other - Org Name:BELHAVEN PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ERTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-944-2272
Mailing Address - Street 1:161 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1448
Mailing Address - Country:US
Mailing Address - Phone:252-944-2272
Mailing Address - Fax:252-944-2270
Practice Address - Street 1:161 E WATER ST
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1448
Practice Address - Country:US
Practice Address - Phone:252-944-2272
Practice Address - Fax:252-944-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC243213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0803KOtherBCBS NC
NC790803KMedicaid
NC0803KOtherBCBS NC
NC790803KMedicaid