Basic Information
Provider Information
NPI: 1003296153
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTHOLOMEW
FirstName: ALAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 88 MDG/SGHJ
Address2: 4881 SUGAR MAPLE DR.
City: WRIGHT PATTERSON AFB
State: OH
PostalCode: 45433
CountryCode: US
TelephoneNumber: 9372576529
FaxNumber:  
Practice Location
Address1: 301 FISHER ST RM 1F325
Address2:  
City: KEESLER AFB
State: MS
PostalCode: 395342508
CountryCode: US
TelephoneNumber: 8017064520
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2015
LastUpdateDate: 08/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500X1747NEY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology
390200000X1747NEN Student, Health CareStudent in an Organized Health Care Education/Training Program 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

ID Information
IDTypeStateIssuerDescription
174705NE MEDICAID


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