Provider Demographics
NPI:1215425053
Name:BERMUDEZ, ANA LAURA (MD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:BERMUDEZ
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 1:102 MASON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-6134
Mailing Address - Country:US
Mailing Address - Phone:919-966-1459
Mailing Address - Fax:919-843-2356
Practice Address - Street 1:6715 MCCRIMMON PKWY FL 3
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-1915
Practice Address - Country:US
Practice Address - Phone:984-215-6380
Practice Address - Fax:984-215-6381
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1215425053.390200000X
NC202101708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty