Provider Demographics
NPI:1427581982
Name:QUEREDA BERNABEU, BELEN
Entity Type:Individual
Prefix:
First Name:BELEN
Middle Name:
Last Name:QUEREDA BERNABEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:APT N301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3714
Mailing Address - Country:US
Mailing Address - Phone:267-370-4739
Mailing Address - Fax:
Practice Address - Street 1:117 S 11TH ST
Practice Address - Street 2:ROOM 204 PAVILLION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4949
Practice Address - Country:US
Practice Address - Phone:215-503-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213078207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology