Provider Demographics
NPI:1447264437
Name:BERTONI, MARIO E (MD)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:E
Last Name:BERTONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4648
Mailing Address - Country:US
Mailing Address - Phone:832-830-8997
Mailing Address - Fax:281-888-3918
Practice Address - Street 1:6550 MAPLERIDGE ST STE 216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4648
Practice Address - Country:US
Practice Address - Phone:832-830-8997
Practice Address - Fax:281-888-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE56822085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE21639Medicare UPIN