Provider Demographics
NPI:1265491708
Name:ST.BERNARD, EDWARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:ST.BERNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SPAULDING RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5115
Mailing Address - Country:US
Mailing Address - Phone:828-652-7776
Mailing Address - Fax:828-652-7807
Practice Address - Street 1:100 SPAULDING RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5115
Practice Address - Country:US
Practice Address - Phone:828-652-7776
Practice Address - Fax:828-652-7807
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979351Medicaid
NC110129712OtherRAILROAD RETIREMENT
NC110129712OtherRAILROAD RETIREMENT
NCF96567Medicare UPIN