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General NPI Number Information
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NPI Number | 1881049146
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Entity Type | Individual
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Provider Name | ILIA BERNSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 3100 MACCORKLE AVE SE STE 700
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City | CHARLESTON
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State | WV
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Zip | 25304-1230
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Country | US
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Telephone | 304-347-1395
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 MACCORKLE AVE SE RM 3058
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City | CHARLESTON
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State | WV
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Zip | 25304-1210
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Country | US
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Telephone | 304-347-1395
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 30880
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License Number State | WV
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