Provider Demographics
NPI:1366441123
Name:REDMOND, BERNIECE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNIECE
Middle Name:ELIZABETH
Last Name:REDMOND
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:843-522-7820
Practice Address - Fax:843-522-7821
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8958707Medicaid
NC94000931OtherSTATE LICENSE
NC2238739Medicare ID - Type Unspecified
NC8958707Medicaid
SC2238739AMedicare PIN
NC94000931OtherSTATE LICENSE