Healthcare Provider Details

I. General information

NPI: 1972798163
Provider Name (Legal Business Name): ERIC BERNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10845 TOWN CENTER BLVD
DUNKIRK MD
20754-2712
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-286-7911
  • Fax: 410-286-7913
Mailing address:
  • Phone: 410-414-4791
  • Fax: 410-414-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0066825
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101241281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: