Provider Demographics
NPI:1164573077
Name:ALBANESE, BERNADETTE A (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:A
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3123
Mailing Address - Country:US
Mailing Address - Phone:719-578-3101
Mailing Address - Fax:719-575-8664
Practice Address - Street 1:301 S UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3123
Practice Address - Country:US
Practice Address - Phone:719-578-3101
Practice Address - Fax:719-575-8664
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO451772080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME54065Medicare UPIN