Provider Demographics
NPI:1003902198
Name:BERNARDO, ELMA ZAPANTA (MD)
Entity Type:Individual
Prefix:
First Name:ELMA
Middle Name:ZAPANTA
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 1:401 DIVISION ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1455
Mailing Address - Country:US
Mailing Address - Phone:304-766-3470
Mailing Address - Fax:304-766-3494
Practice Address - Street 1:401 DIVISION ST STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-766-3470
Practice Address - Fax:304-766-3494
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV123942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV033183OtherVALUE OPTIONS
WV0116974000Medicaid
WVV002773OtherAVTAL OHIO WC
WV1042627OtherWORKERS COMPENSATION
WVC35044Medicare UPIN
WV0116974000Medicaid