Provider Demographics
NPI:1033158217
Name:BERNIE, HOWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:L
Last Name:BERNIE
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 1:520 EATON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2716
Mailing Address - Country:US
Mailing Address - Phone:513-896-2200
Mailing Address - Fax:513-894-0096
Practice Address - Street 1:520 EATON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2716
Practice Address - Country:US
Practice Address - Phone:513-896-2200
Practice Address - Fax:513-894-0096
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042321207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64203011Medicaid
OH060001019OtherRR MEDICARE
OH0480199Medicaid
IN100005700Medicaid
OH0480199Medicaid
OH0495691Medicare PIN
IN100005700Medicaid