MEDICARE: DAVID A BERNITSKY MD

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	207W00000X	Ophthalmology Physician	88122	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM010346	OTHER		BCBS

General Provider Information

NPI Number	:	1851384861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A BERNITSKY MD

Provider Business Mailing Address
First Line	:	6401 HOLLY AVENUE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1735
Country	:	US
Telephone Number	:	505-323-0800
Fax Number	:	505-323-6221

Provider Business Practice Location Address
First Line	:	6401 HOLLY AVENUE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1735
Country	:	US
Telephone Number	:	505-323-0800
Fax Number	:	505-323-6221

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/13/2018

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Directions to “ DAVID A BERNITSKY MD” Practice Location

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