Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake Lee Bertolino

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1477136711

Blake Lee Bertolino is a Student in an Organized Health Care Education/Training Program in Charlotte, North Carolina. Practices as a sole proprietor and works from 2 locations. Licensed in North Carolina.

Licensed in
NC
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

6324 Fairview Rd Ste 400
Charlotte, NC 28210-4278
Phone: (406) 281-1173
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2401 W Omaha St Apt 1224, Broken Arrow, OK 74012-0643 — (406) 281-1173

Specialties & licences

Neurology Physician (primary) Taxonomy 2084N0400X · Licence 2026-04025 (NC)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1477136711
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 4, 2021
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026

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