Provider Demographics
NPI:1154342004
Name:BERTA, JULIUS W (MD)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:W
Last Name:BERTA
Suffix:
Gender:M
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:PO BOX 456
Mailing Address - Street 2:213 THIRD AVE
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-0456
Mailing Address - Country:US
Mailing Address - Phone:814-723-1689
Mailing Address - Fax:814-723-9276
Practice Address - Street 1:2-12 CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016378E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007226600001Medicaid
PABE179736Medicare PIN
PA0007226600001Medicaid