Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 21795 | WV |
N | 207RN0300X | Nephrologist | 35085454 | OH |
Y | 207RN0300X | Nephrologist | MD053458L | PA |
NPI | 1003813130 |
---|---|
Provider Name | Jose Bernardo |
First Address | Indiana, PA 15701-3628 |
Second Address | Indiana, PA 15701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 14/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38697 | (02) |