Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 4807 | KY |
NPI | 1659321495 |
---|---|
Provider Name | Dr. Mark L. Bernstein |
First Address | Louisville, KY 40292-0001 |
Second Address | Louisville, KY 40292-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 07/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000311546 | ANTHEM BC BS (01) | KY |
4013501 | ORAL PATH MEDICARE PIN (01) | KY |
50015221 | PASSPORT HEALTH PLAN (01) | KY |
60003381 | (05) | KY |
9178936 | DORAL DENTAL (01) | KY |
T53934 | (02) | KY |
W01743 | ORAL PATH LAB UPIN (01) | KY |