Provider Demographics
NPI:1114001278
Name:BERNOSKY, EDITH (MD)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:
Last Name:BERNOSKY
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 1:11130 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4513
Mailing Address - Country:US
Mailing Address - Phone:919-488-4094
Mailing Address - Fax:919-488-4096
Practice Address - Street 1:11130 CAPITAL BLVD
Practice Address - Street 2:GROWING CHILD PEDIATRICS, PA
Practice Address - City:WAKE FORST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-488-0015
Practice Address - Fax:919-488-0021
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-01186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137C7Medicaid
NC89137C7Medicare ID - Type Unspecified
E69464Medicare ID - Type Unspecified