Healthcare Provider Details

I. General information

NPI: 1538268313
Provider Name (Legal Business Name): MARIA BERNARDI P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 E MAIN ST
BRIDGEPORT CT
06608-1913
US

IV. Provider business mailing address

982 E MAIN ST
BRIDGEPORT CT
06608-1913
US

V. Phone/Fax

Practice location:
  • Phone: 203-696-3260
  • Fax:
Mailing address:
  • Phone: 203-696-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number000976
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: