Barry Bertolasio, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

1840 Gator Blvd
Building 3841
Virginia Beach, VA 23459-8931

Phone

(757) 763-3321

NPI assigned

Oct 10, 2013

Last updated

Oct 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381363200000",
    "number": "1164859930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 CRASHAW ST",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234626913",
            "telephone_number": "757-288-5747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 GATOR BLVD",
            "address_2": "BUILDING 3841",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234598931",
            "telephone_number": "757-763-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTOLASIO",
        "first_name": "BARRY",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Independent Duty Corpsman in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Independent Duty Corpsman in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.