Provider Demographics
NPI:1487762043
Name:BERNARDO, MARIA LOURDES (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
Last Name:BERNARDO
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:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-0312
Mailing Address - Country:US
Mailing Address - Phone:334-738-7337
Mailing Address - Fax:334-513-1665
Practice Address - Street 1:111 SCOUTING CIR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2540
Practice Address - Country:US
Practice Address - Phone:334-770-7337
Practice Address - Fax:334-440-8508
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050990Medicaid
AL051050990OtherBCBS
AL000050990Medicaid
AL051050990OtherBCBS