Provider Demographics
NPI:1528033321
Name:BERNE, ELLEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:S
Last Name:BERNE
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 1:120 LYTTON AVE
Mailing Address - Street 2:SUITE M059
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1481
Mailing Address - Country:US
Mailing Address - Phone:412-623-8905
Mailing Address - Fax:412-623-8906
Practice Address - Street 1:120 LYTTON AVE
Practice Address - Street 2:SUITE M059
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1481
Practice Address - Country:US
Practice Address - Phone:412-623-8905
Practice Address - Fax:412-623-8906
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040062E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011722700012Medicaid
PA0011722700008Medicaid
PA444560R7RMedicare PIN
PAE73205Medicare UPIN
PACG1496Medicare PIN
PA0011722700012Medicaid