Provider Demographics
NPI:1598764870
Name:BERNARDO, MICHAEL JEROME (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEROME
Last Name:BERNARDO
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 1:1109 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3443
Mailing Address - Country:US
Mailing Address - Phone:803-321-3035
Mailing Address - Fax:803-321-3034
Practice Address - Street 1:1109 WILSON ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3443
Practice Address - Country:US
Practice Address - Phone:803-321-3035
Practice Address - Fax:803-321-3034
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL3672Medicaid
SCTL3672Medicaid