Provider Demographics
NPI:1992889067
Name:BERNSTEIN, ALLAN L (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:L
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:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:GRATON
Mailing Address - State:CA
Mailing Address - Zip Code:95444-0625
Mailing Address - Country:US
Mailing Address - Phone:707-823-7616
Mailing Address - Fax:
Practice Address - Street 1:652 PETALUMA AVE
Practice Address - Street 2:SUITE H
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4256
Practice Address - Country:US
Practice Address - Phone:707-823-7616
Practice Address - Fax:707-823-2803
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG220902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G220900Medicaid
F20275Medicare UPIN
00G220900Medicare ID - Type Unspecified