Provider Demographics
NPI:1528030129
Name:BERNBAUM, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BERNBAUM
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 1:3025 C G ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1131
Mailing Address - Country:US
Mailing Address - Phone:610-384-2211
Mailing Address - Fax:610-384-2340
Practice Address - Street 1:3025 C G ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1131
Practice Address - Country:US
Practice Address - Phone:610-384-2211
Practice Address - Fax:610-384-2340
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016865E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007031450002Medicaid
PA0026193000OtherINDEPENDENCE BLUE CROSS
PAB37421Medicare UPIN
PA126730FGMMedicare ID - Type Unspecified