Provider Demographics
NPI:1205858651
Name:BERNEY, SETH MARK (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:MARK
Last Name:BERNEY
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 1:34 AURIEL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9111
Mailing Address - Country:US
Mailing Address - Phone:318-470-7311
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE STE 445
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1912
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2014-141207RR0500X
LA11280R207RR0500X
VA0101277003207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669938Medicaid
LA1669938Medicaid
LAE20736Medicare UPIN