Provider Demographics
NPI:1760194112
Name:AMALIMEH, BERNARD
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:AMALIMEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 WENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3151
Mailing Address - Country:US
Mailing Address - Phone:618-558-7165
Mailing Address - Fax:
Practice Address - Street 1:10655 WENNINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-3151
Practice Address - Country:US
Practice Address - Phone:618-558-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR254301363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health