Provider Demographics
NPI: | 1215921994 |
---|---|
Name: | BERNSTEIN, HAROLD ADAM (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | HAROLD |
Middle Name: | ADAM |
Last Name: | BERNSTEIN |
Suffix: | |
Gender: | M |
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: | 6160 KEMPSVILLE CIR STE 250B |
Mailing Address - Street 2: | |
Mailing Address - City: | NORFOLK |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23502-3933 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-481-4400 |
Mailing Address - Fax: | 757-481-1285 |
Practice Address - Street 1: | 6160 KEMPSVILLE CIR STE 120B |
Practice Address - Street 2: | |
Practice Address - City: | NORFOLK |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23502-3933 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-481-4400 |
Practice Address - Fax: | 757-481-1285 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-09-08 |
Last Update Date: | 2024-02-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101056134 | 207W00000X, 207WX0009X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207WX0009X | Allopathic & Osteopathic Physicians | Ophthalmology | Glaucoma Specialist |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 010072786 | Medicaid | |
H91026 | Medicare UPIN | ||
VA | 010072786 | Medicaid |