Healthcare Provider Details

I. General information

NPI: 1831190040
Provider Name (Legal Business Name): GEORGE A BERNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 CAMPBELL WAY STE 101
BREMERTON WA
98310-3351
US

IV. Provider business mailing address

2520 CHERRY AVE
BREMERTON WA
98310-4229
US

V. Phone/Fax

Practice location:
  • Phone: 360-479-4203
  • Fax: 360-478-7240
Mailing address:
  • Phone: 360-377-3911
  • Fax: 360-478-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD00015888
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD00015888
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: