Provider Demographics
NPI:1174850952
Name:BERNESCU, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:BERNESCU
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 1:3407 WILKENS AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5074
Mailing Address - Country:US
Mailing Address - Phone:443-574-8500
Mailing Address - Fax:410-719-0094
Practice Address - Street 1:3407 WILKENS AVE STE 410
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:443-574-8500
Practice Address - Fax:410-719-0094
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106001208C00000X
390200000X
MDD85056208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070725Medicaid
AZ1174850952Medicare UPIN