Provider Demographics
NPI:1053566299
Name:BERTRAND, KAREN IRINDA (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:IRINDA
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7647 BROADFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104
Mailing Address - Country:US
Mailing Address - Phone:315-247-3060
Mailing Address - Fax:
Practice Address - Street 1:132 1/2 ALBANY STREET
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035
Practice Address - Country:US
Practice Address - Phone:315-655-8171
Practice Address - Fax:315-655-5923
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259421207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03461956Medicaid
NY03461956Medicaid