# DR. CHARLES JOSEPH BERTUCH JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1316056013
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 99421-1 | NY | — |
| 202C00000X | Independent Medical Examiner Physician | 099426 | NY | Yes |
| 2083A0300X | Addiction Medicine (Preventive Medicine) Physician | DR.0052261 | CO | — |

## Other

- **Enumeration date:** 08/29/2006
- **Last updated:** 05/03/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0000CM0523 | RAILROAD MEDICARE | — |
| 01 | — | 000405418002 | BSH NE NY | NY |
| 05 | — | 00553493 | — | NY |
| 01 | — | 18111 | MVP HEALTHPLAN | NY |