Provider Demographics
NPI:1215983440
Name:BERNENS, ANTHONY T (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:T
Last Name:BERNENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-952-5545
Mailing Address - Fax:925-952-5541
Practice Address - Street 1:2637 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2512
Practice Address - Country:US
Practice Address - Phone:925-952-5545
Practice Address - Fax:925-952-5541
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110156852OtherRAILROAD MEDICARE
CA00A551640Medicaid
CA110156852OtherRAILROAD MEDICARE
CAG65966Medicare UPIN
CA00A551640Medicaid