Provider Demographics
NPI:1003095571
Name:BERNARD, MARNIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARNIE
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19777 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-1307
Mailing Address - Country:US
Mailing Address - Phone:888-808-6483
Mailing Address - Fax:
Practice Address - Street 1:19777 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-1307
Practice Address - Country:US
Practice Address - Phone:888-808-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003225363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical