Provider Demographics
NPI:1760564132
Name:BERNANKE, A. DAVID (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:DAVID
Last Name:BERNANKE
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 1:4660 KENMORE AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1300
Mailing Address - Country:US
Mailing Address - Phone:703-751-6582
Mailing Address - Fax:703-751-1437
Practice Address - Street 1:4660 KENMORE AVE STE 604
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1300
Practice Address - Country:US
Practice Address - Phone:703-751-6582
Practice Address - Fax:703-751-1437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016723207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB558-0001OtherCAREFIRST BCBS
VAA56751Medicare UPIN
VA145875Medicare PIN