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General NPI Number Information
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NPI Number | 1336110543
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Entity Type | Individual
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Provider Name | MARC J BERNSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 621 S NEW BALLAS RD STE 598A
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8262
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Country | US
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Telephone | 314-251-3380
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Fax | 314-251-3385
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Provider Business Mailing Address
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Address Line | 1 CLERBROOK LN
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MO101070
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License Number State | MO
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