Healthcare Provider Details

I. General information

NPI: 1255373692
Provider Name (Legal Business Name): NELSON LIM BERNARDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW SUITE 4B-1
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

110 IRVING ST NW SUITE 4B-1
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-5975
  • Fax: 202-877-3339
Mailing address:
  • Phone: 202-877-5975
  • Fax: 202-877-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101051607
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101051607
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: