MEDICARE: BASIL BERNSTEIN MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F3043	TX

General Provider Information

NPI Number	:	1093976334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIL BERNSTEIN MD PA

Provider Business Mailing Address
First Line	:	7016 BRYANT IRVIN RD # 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4120
Country	:	US
Telephone Number	:	817-377-8820
Fax Number	:	817-377-8450

Provider Business Practice Location Address
First Line	:	7016 BRYANT IRVIN RD # 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4120
Country	:	US
Telephone Number	:	817-377-8820
Fax Number	:	817-377-8450

Authorized Official
Title or Position	:	PRESIDENT-OWNER
Name	:	DR. BASIL BERNSTEIN
Credential	:	MD PA
Telephone Number	:	817-377-8820

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	08/14/2015

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