Provider Demographics
NPI:1295007052
Name:LIVEWELL, BERNADETTE (PA)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:LIVEWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1110
Mailing Address - Country:US
Mailing Address - Phone:856-222-4444
Mailing Address - Fax:856-222-0049
Practice Address - Street 1:4000 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1110
Practice Address - Country:US
Practice Address - Phone:856-222-4444
Practice Address - Fax:856-222-0049
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00277600207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ236598RPBMedicare PIN