Provider Demographics
NPI:1700847449
Name:PRITCHETT, BERNICE A (MD)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:A
Last Name:PRITCHETT
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 1:3701 AVALON PARK WEST BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7303
Mailing Address - Country:US
Mailing Address - Phone:407-306-0982
Mailing Address - Fax:407-384-7754
Practice Address - Street 1:3701 AVALON PARK WEST BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7303
Practice Address - Country:US
Practice Address - Phone:407-306-0982
Practice Address - Fax:407-384-7754
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301095245207Q00000X
OH35083607207Q00000X
FLME125703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR2028241OtherMEDICARE
MI1700847449Medicaid
OH2531906Medicaid
MIN72760027Medicare PIN