Provider Demographics
NPI:1760942288
Name:BERTHA, NICHOLAS M (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:BERTHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 401
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-267-9400
Mailing Address - Fax:856-809-2334
Practice Address - Street 1:200 BOWMAN DR STE E100
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9648
Practice Address - Country:US
Practice Address - Phone:609-267-9400
Practice Address - Fax:856-809-2334
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA12757400207X00000X
CODR.0072755207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine