MEDICARE: BERNARD N DEAN JR.

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	237700000X	Hearing Instrument Specialist	2101000339	VA

General Provider Information

NPI Number	:	1831729649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD N DEAN JR.

Provider Business Mailing Address
First Line	:	4890 FORT AVE
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1535
Country	:	US
Telephone Number	:	434-237-6295
Fax Number	:

Provider Business Practice Location Address
First Line	:	4890 FORT AVE
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1535
Country	:	US
Telephone Number	:	434-237-6295
Fax Number	:

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

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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