1528252756 NPI number — JULIETTE ALTHEA BERNIS APN

Table of content: JULIETTE ALTHEA BERNIS APN (NPI 1528252756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528252756 NPI number — JULIETTE ALTHEA BERNIS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNIS
Provider First Name:
JULIETTE
Provider Middle Name:
ALTHEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINTERS
Provider Other First Name:
JULIETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528252756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1589 SULPHUR SPRING RD
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21227-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-536-5400
Provider Business Mailing Address Fax Number:
410-737-2168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5999 HARPERS FARM RD
Provider Second Line Business Practice Location Address:
SUITE W 250
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-772-8822
Provider Business Practice Location Address Fax Number:
410-772-9274
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R208053 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0799084 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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