Provider Demographics
NPI:1043824998
Name:HAMBIDGE, BERTHA BOWEN (MD)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:BOWEN
Last Name:HAMBIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:BOWEN
Other - Last Name:HAMBIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4300 SAPPHIRE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9079
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:
Practice Address - Street 1:2602 COURTIER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7818
Practice Address - Country:US
Practice Address - Phone:252-752-0483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC319942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry