Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 226816 | MA |
N | 213ES0000X | Sports Medicine | 226816 | MA |
Y | 2081S0010X | Sports Medicine | 54547 | GA |
Y | 213ES0000X | Sports Medicine | 54547 | GA |
NPI | 1407824576 |
---|---|
Provider Name | Maurice R Bernaiche |
First Address | Dalton, GA 30720-2631 |
Second Address | Dalton, GA 30720-2631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000032786 | BMC (01) | MA |
142672 | (02) | TN |
226816 | CONNECTICARE (01) | MA |
37645 | HEALTH NEW ENGLAND (01) | MA |
478927 | TUFTS (01) | MA |
7421780 | AETNA (01) | MA |
8900941 | CIGNA (01) | MA |
AA53780 | HARVARD PILGRIM (01) | MA |
J29800 | BCBS MA (01) | MA |