Provider Demographics
NPI:1336110477
Name:BERNAD, PETER G (MD, MPH, FACP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:BERNAD
Suffix:
Gender:M
Credentials:MD, MPH, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-360-8200
Mailing Address - Fax:703-360-3178
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-8200
Practice Address - Fax:703-360-3178
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1010314802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039641700Medicaid
MD219291801Medicaid
VA6195806Medicaid
VA130000809Medicare ID - Type UnspecifiedVA AREA MEDICARE #
A67866Medicare UPIN
MD219291801Medicaid