Provider Demographics
NPI:1639178551
Name:BERNSTEIN, GUY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:T
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 1:245 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2221
Mailing Address - Country:US
Mailing Address - Phone:610-525-2515
Mailing Address - Fax:610-527-6586
Practice Address - Street 1:245 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2221
Practice Address - Country:US
Practice Address - Phone:610-525-2515
Practice Address - Fax:610-527-6586
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041200E174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23155OtherAETNA
PA0015278930002Medicaid
PA0098070000OtherKEYSTONE HEALTH PLAN EAST
PA340008589OtherRAILROAD MEDICARE
PA406770OtherBLUE SHIELD
PA23155OtherAETNA
PA0098070000OtherKEYSTONE HEALTH PLAN EAST