Provider Demographics
NPI:1518915008
Name:BERNSTEIN, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
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 777
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-0777
Mailing Address - Country:US
Mailing Address - Phone:662-539-0233
Mailing Address - Fax:662-538-0996
Practice Address - Street 1:303 J H PHILLIPS LANE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652
Practice Address - Country:US
Practice Address - Phone:662-539-0233
Practice Address - Fax:662-538-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17918174400000X
PAMD043199L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00051759OtherRAILROAD MEDICARE
MS07752582Medicaid
MSP00051759OtherRAILROAD MEDICARE
MS340000240Medicare ID - Type Unspecified