Provider Demographics
NPI:1063409910
Name:WELLS, BERNADETTE (MD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 LAFAYETTE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4266
Mailing Address - Country:US
Mailing Address - Phone:540-891-0246
Mailing Address - Fax:540-891-0584
Practice Address - Street 1:4107 LAFAYETTE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4266
Practice Address - Country:US
Practice Address - Phone:540-891-0246
Practice Address - Fax:540-891-0584
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044803208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics