Provider Demographics
NPI:1588771471
Name:LERTZMAN, BETH H (MD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:H
Last Name:LERTZMAN
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 1:300 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1606
Mailing Address - Country:US
Mailing Address - Phone:585-424-6770
Mailing Address - Fax:585-424-6776
Practice Address - Street 1:300 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197921-1174400000X
NY197921207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16828AMedicare ID - Type Unspecified
NYG49816Medicare UPIN