Individual
DR. CHARLES JOSEPH BERTUCH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 E ELIZABETH STREET, FORT COLLINS, CO 80524
(970) 493-9193
(970) 639-4475
Mailing address
1120 E ELIZABETH STREET, FORT COLLINS, CO 80524
(970) 493-9193
(970) 639-4475
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
99421-1
NY
202C00000X
Independent Medical Examiner Physician
Primary
099426
NY
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
DR.0052261
CO
Other
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
Enumeration date
08/29/2006
Last updated
05/03/2019
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