MEDICARE: DR. JEFFREY D BERNHARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	45966	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720061302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D BERNHARD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 62
Second Line	:	TURNPIKE STATION
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-0062
Country	:	US
Telephone Number	:	508-334-8815
Fax Number	:	508-334-5374

Provider Business Practice Location Address
First Line	:	340 MAPLE ST STE 203
Second Line	:	KUCHNIR DERMATOLOGY
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-3200
Country	:	US
Telephone Number	:	508-485-7769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	05/13/2013

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