Barry Bertolasio, IDC
Military Health Care Provider, Independent Duty Corpsman in Virginia Beach, VA. Individual provider (NPI-1).
NPI number1164859930
StatusActive
Last updated in NPPESOct 10, 2013
Details
- NPI
- 1164859930
- Entity type
- Individual (NPI-1)
- Name
- Barry Bertolasio
- Credential
- IDC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 10, 2013
- Last updated
- Oct 10, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
1840 Gator BlvdBuilding 3841
Virginia Beach, VA 23459-8931
Phone 757-763-3321
Mailing address
835 Crashaw StVirginia Beach, VA 23462-6913
Phone 757-288-5747
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