1538158738 NPI number — ELLEN E BERNARD DO

Table of content: ELLEN E BERNARD DO (NPI 1538158738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538158738 NPI number — ELLEN E BERNARD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNARD
Provider First Name:
ELLEN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMARCO
Provider Other First Name:
ELLEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538158738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HOLLAND WAY FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXETER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03833-2997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-693-2100
Provider Business Mailing Address Fax Number:
603-679-1046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 CALEF HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPPING
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03042-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-693-2100
Provider Business Practice Location Address Fax Number:
603-679-1046
Provider Enumeration Date:
10/19/2005

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: 207Q00000X , with the licence number:  13236 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3076269 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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