Provider Demographics
NPI:1063742989
Name:BERNARD L PACELLA JR MD PA
Entity type:Organization
Organization Name:BERNARD L PACELLA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PACELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-385-3614
Mailing Address - Street 1:200 MISSION RD
Mailing Address - Street 2:STE 100-101
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2618
Mailing Address - Country:US
Mailing Address - Phone:386-385-3614
Mailing Address - Fax:386-385-3874
Practice Address - Street 1:200 MISSION RD
Practice Address - Street 2:STE 100-101
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2618
Practice Address - Country:US
Practice Address - Phone:386-385-3614
Practice Address - Fax:386-385-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty