Provider Demographics
NPI:1114024312
Name:BERNARD J DURANTE MD PC
Entity Type:Organization
Organization Name:BERNARD J DURANTE MD PC
Other - Org Name:PLYMOUTH EARS NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERANRD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-746-8977
Mailing Address - Street 1:30 ALDRIN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4804
Mailing Address - Country:US
Mailing Address - Phone:508-746-8977
Mailing Address - Fax:508-746-3364
Practice Address - Street 1:30 ALDRIN RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4804
Practice Address - Country:US
Practice Address - Phone:508-746-8977
Practice Address - Fax:508-746-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58069207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9771091Medicaid
MAM17916OtherBLUECROSS BLUESHIELD
MA711390OtherTUFTS HEALTH PLAN
MA2652138OtherAETNA
MA1000029OtherUNITED HEALTH CARE
MA19073OtherHARVARD PILGRIM HEALTH
MA9771091Medicaid