Provider Demographics
NPI:1437109451
Name:MACLEOD, BERNADETTE P (CPNP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:P
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4116
Mailing Address - Country:US
Mailing Address - Phone:716-662-7337
Mailing Address - Fax:716-662-0641
Practice Address - Street 1:5800 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4116
Practice Address - Country:US
Practice Address - Phone:716-662-7337
Practice Address - Fax:716-662-0641
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3806231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005602761OtherBLUE CROSS BLUE SHIELD
NY00026522001OtherUNIVERA HEALTHCARE
NY9512020OtherINDEPENDENT HEALTH