Provider Demographics
NPI:1497876635
Name:BERNIER, ELISE C (MD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:C
Last Name:BERNIER
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 1:2280 DESCARTES STREET
Mailing Address - Street 2:
Mailing Address - City:SHERBROOKE PQ
Mailing Address - State:QC
Mailing Address - Zip Code:JIJ4A4
Mailing Address - Country:CA
Mailing Address - Phone:819-822-2555
Mailing Address - Fax:
Practice Address - Street 1:80 VIMY NORD
Practice Address - Street 2:
Practice Address - City:SHERBROOKE
Practice Address - State:QC
Practice Address - Zip Code:J1J3M4
Practice Address - Country:CA
Practice Address - Phone:819-822-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice