Healthcare Provider Details

I. General information

NPI: 1104963859
Provider Name (Legal Business Name): ANDREW S BERNSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S HAYS ST
BEL AIR MD
21014-3644
US

IV. Provider business mailing address

2522 CHESTNUT WOODS CT
REISTERSTOWN MD
21136-5523
US

V. Phone/Fax

Practice location:
  • Phone: 410-638-8410
  • Fax: 410-420-3446
Mailing address:
  • Phone: 410-638-8410
  • Fax: 410-420-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0043437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: