Provider Demographics
NPI:1003801887
Name:BERNARDO, WILFRIDO D (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRIDO
Middle Name:D
Last Name:BERNARDO
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 176
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-0176
Mailing Address - Country:US
Mailing Address - Phone:615-735-0700
Mailing Address - Fax:615-735-5451
Practice Address - Street 1:130 LEBANON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2955
Practice Address - Country:US
Practice Address - Phone:615-735-0700
Practice Address - Fax:615-735-5451
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11479208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170708Medicaid
B03418Medicare UPIN
TN3170708Medicaid