Healthcare Provider Details

I. General information

NPI: 1295718534
Provider Name (Legal Business Name): RICHARD A BERNING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD A BERNING

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH HILL RD SUITE 1A
SANDY HOOK CT
06482-1108
US

IV. Provider business mailing address

107 CHURCH HILL RD SUITE 1A
SANDY HOOK CT
06482-1108
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-0225
  • Fax: 203-426-0249
Mailing address:
  • Phone: 203-426-0225
  • Fax: 203-426-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number034959
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: