Provider Demographics
NPI:1073595203
Name:BERNARDO, DEAN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:MANUEL
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 1:1661 HOLLAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-843-7800
Mailing Address - Fax:419-843-3444
Practice Address - Street 1:1661 HOLLAND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-843-7800
Practice Address - Fax:419-843-3444
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066125B207RC0200X, 207RP1001X
OH35066125207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH290010946OtherMEDICARE RAILRAOD
OH0956023Medicaid
OH0849026Medicare PIN
OH0956023Medicaid
OHF78296Medicare UPIN
OH0849023Medicare PIN
OH0849021Medicare PIN