DR. EDWARD JOHN BERTACCINI (NPI# 1063432623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063432623 |
| Entity Type | Individual |
| Full Name | DR. EDWARD JOHN BERTACCINI |
| Credential | MD |
| Practice Address |
3801 Miranda Ave Dept. of Anesthesia, 112a, Palo Alto Va Hospital Palo Alto CA 94304-1207 |
| Practice Telephone | 6504935000 |
| Practice Fax Number | 6508523423 |
| Mailing Telephone | 6504935000 |
| Mailing Fax Number | 6508523423 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LC0200X |
Anesthesiology Specialization: Critical Care Medicine |
G71364 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
3801 MIRANDA AVE DEPT. OF ANESTHESIA, 112A, PALO ALTO VA HOSPITAL |
| City | PALO ALTO |
| State | CA |
| Zip Code | 94304-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962405449 | John Paul Lavelle | Urology | 3801 Miranda Ave, B3-117 Bldg 100 Urology (#112), Palo Alto, CA 94304-1207 | 2005-05-27 |
| 1437750619 | Ashley Ando | Respiratory Therapist, Registered | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-11-04 |
| 1265032783 | Jim Le | Occupational Therapist | 3801 Miranda Ave, Palo Alto, CA 94304-1290 | 2020-10-26 |
| 1497354484 | Laura Renee Zimmerman | Registered Nurse | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-10-21 |
| 1891300810 | Clark Dan Ma | Pharmacist | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-09-15 |
| 1124630900 | Palo Alto Perfusion Service | Perfusionist | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-08-21 |
| 1790397362 | Gihun Kim | Pharmacist | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-08-17 |
| 1750993309 | Jessica Tran | Pharmacist | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-08-17 |
| 1083226500 | Danielle Jean Fox | Pharmacist | 3801 Miranda Ave, Palo Alto, CA 94304-1290 | 2020-08-17 |
| 1346851078 | Alice Lin | Pharmacist | 3801 Miranda Ave, Palo Alto, CA 94304-1207 | 2020-08-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477170611 | Richard Engdahl | Specialist/Technologist, Other | 820 Quarry Road, Mc1078 Hf006, Palo Alo, CA 94304 | 2020-07-04 |
| 1720603582 | Lily Wenya Zhou | Psychiatry & Neurology | 780 Welch Road, Suite 350, Stanford Stroke Center, Palo Alto, CA 94304 | 2020-06-08 |
| 1033738521 | Perry Seo Choi | Student in an Organized Health Care Education/Training Program | Dept of Cardiothoracic Surgery, Falk Building, 870 Quarry Rd, Palo Alto, CA 94304 | 2020-04-14 |
| 1073150355 | Tara Mcdermott | Nurse Practitioner | 500 Pasteur Drive, Cardiovascular Intensive Care Unit, Palo Alto, CA 94304 | 2019-12-05 |
| 1811542723 | Mark Henry Chubb | Pediatrics | Stanford Children's Health, 725 Welch Road, Palo Alto, CA 94304 | 2019-08-07 |
| 1194285114 | Cora Steindl | Nurse Practitioner | 300 Pasteur Drive Rm H2512, Stanford, CA 94304 | 2019-03-25 |
| 1407333057 | Deborah Menet Landi | Social Worker | Lucile Packard Children's Hospital Stanford, 725 Welch, Mc 5933, Palo Alto, CA 94304 | 2018-07-26 |
| 1982100798 | Jonathan Hootman | Student in an Organized Health Care Education/Training Program | 900 Quarry Road Extension, Palo Alto, CA 94304 | 2018-04-02 |
| 1093234254 | Adam C Maclellan | Psychiatry & Neurology | Stanford Stroke Center, 780 Welch Road, Suite 350, Palo Alto, CA 94304 | 2017-09-19 |
| 1194248153 | Chanel Beaudoin Cloutier | Plastic Surgery | 770 Welch Road, Suite 400, Palo Alto, CA 94304 | 2017-07-21 |
| Find all providers in zip 94304 | ||||
| Taxonomy Code | 207LC0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Critical Care Medicine |
| An anesthesiologist, who specializes in critical care medicine diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417208596 | Pacific Physicians Medical, Inc. | Anesthesiology | 573 Center Dr, Palo Alto, CA 94301-3102 | 2012-09-28 |
| 1265677728 | Guy Miller | Anesthesiology | 3801 Miranda Avenue, Va Palo Alto Health Care, Palo Alto, CA 94304 | 2008-12-11 |
| 1144331018 | Juliana Barr | Anesthesiology | 3801 Miranda Ave, Anesthesiology Service (112a), Palo Alto, CA 94304-1207 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851899876 | Dennis Thomas Mangano | Anesthesiology | 30 Genevra Rd, Hillsborough, CA 94010-6423 | 2018-01-24 |
| 1801282579 | Sara Sedrak | Anesthesiology | 127 S San Vicente Blvd Ste 3100, Los Angeles, CA 90048-3311 | 2015-04-09 |
| 1649699505 | Christopher Dinh | Anesthesiology | 2500 Grant Rd # 2a302, Mountain View, CA 94040-4302 | 2014-04-08 |
| 1295178002 | Deon We-jin Lau | Anesthesiology | 11234 Anderson St # 2539, Loma Linda, CA 92354 | 2013-04-10 |
| 1225356777 | Dante William Oriente | Anesthesiology | 972 Calle Serra, San Dimas, CA 91773-4332 | 2010-05-07 |
| 1578793279 | Christopher George Choukalas | Anesthesiology | 120 Parker Ave, #102, San Francisco, CA 94118-2673 | 2009-07-16 |
| 1225219025 | Robert Chan Ang | Anesthesiology | 500 E Remington Dr Ste 18, Sunnyvale, CA 94087-2611 | 2007-11-20 |
| 1780746354 | Lundy John Campbell | Anesthesiology | 512 Parnassus Ave, Room S-436, Box 0427, San Francisco, CA 94143-0001 | 2006-12-13 |
| 1407835325 | Mojdeh Talebian | Anesthesiology | 2950 Whipple Ave, #4, Redwood City, CA 94062 | 2006-01-10 |
| 1902885957 | John William Marcum | Anesthesiology | 5021 Verdugo Way, Camarillo, CA 93012-8675 | 2006-01-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.