| Doctor Name: | DR. MAX ERWIN BERTHOLF |
| NPI Number: | 1619147691 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101012335 |
| Business Practice Address: | 498 Coyner Springs Rd Roanoke Valley Juvenile Detention Center, Med. Director Roanoke, VA - 240129038 |
| Business Phone Number: | 5405613840 |
| Business Fax Number: | 5405613848 |
| Mailing Address: | 200 The Glebe Blvd, #3010 DALEVILLE |
| State: | VA |
| Postal Code: | 240833726 |
| Phone Number: | 5405912333 |
| Fax Number: | 5405912333 |
| NPI Enumeration Date: | 03/06/2008 |
| NPI Last Update Date: | 03/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101012335 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |