1831190040 NPI number — GEORGE A BERNI MD

Table of content: GEORGE A BERNI MD (NPI 1831190040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831190040 NPI number — GEORGE A BERNI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNI
Provider First Name:
GEORGE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1831190040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 CHERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-4229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-377-3911
Provider Business Mailing Address Fax Number:
360-478-7240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 CAMPBELL WAY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-479-4203
Provider Business Practice Location Address Fax Number:
360-478-7240
Provider Enumeration Date:
08/10/2005

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: 2086S0129X , with the licence number:  MD00015888 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208G00000X , with the licence number: MD00015888 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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