Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101045738 | VA |
Y | 207X00000X | Orthopaedic Surgeon | D0046117 | MD |
N | 207XS0106X | Orthopaedic Hand Surgeon | C10005022 | DE |
NPI | 1154339620 |
---|---|
Provider Name | Stacey Hale Berner |
First Address | Owings Mills, MD 21117-5458 |
Second Address | Owings Mills, MD 21117-5458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 03/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160631000 | (05) | MD |
53253404 | BLUE SHIELD (01) | MD |
F86894 | (02) | |
W5200002 | BLUE SHIELD (01) | DC |