Provider Demographics
NPI:1093715906
Name:BERNSTEIN, LAWRENCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:H
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:260 NEW LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:262 NEW LUDLOW RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4324
Practice Address - Country:US
Practice Address - Phone:413-552-3250
Practice Address - Fax:413-552-3255
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155817207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
710779OtherHARVARD PILGRIM
J18507OtherBCBS OF MA
MA6188354Medicaid
017816OtherCONNECTICARE OF MA
974611OtherNETWORK HEALTH
000000001890OtherBOSTON MEDICAL CENTER HNP
J18507OtherHMO BLUE
043202198007OtherTRICARE
5311957012OtherCIGNA
24948OtherHEALTH NEW ENGLAND
043202198007OtherTRICARE
MAA23261Medicare ID - Type Unspecified