Provider Demographics
NPI:1710057625
Name:BERNARD, MARIE G (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:G
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROUTE 31
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5795
Mailing Address - Country:US
Mailing Address - Phone:908-284-9880
Mailing Address - Fax:908-782-4316
Practice Address - Street 1:111 RT 31
Practice Address - Street 2:SUITE 111
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5772
Practice Address - Country:US
Practice Address - Phone:908-284-9880
Practice Address - Fax:908-782-4316
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05548300207Q00000X
NJMA55483208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080123744OtherRAILROAD MEDICARE ID#
NJF41659Medicare PIN