Provider Demographics
NPI:1053464909
Name:SOLOUNIAS, BERNADETTE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:LOUISE
Last Name:SOLOUNIAS
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 1:800 TYDINGS LN
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2132
Mailing Address - Country:US
Mailing Address - Phone:410-273-6600
Mailing Address - Fax:
Practice Address - Street 1:800 TYDINGS LN
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2132
Practice Address - Country:US
Practice Address - Phone:410-273-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034114324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MPE28709Medicare UPIN