Provider Demographics
NPI:1790722874
Name:BERNSTEIN, DAVID ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3409
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1325
Practice Address - Street 1:2424 ENTERPRISE RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1704
Practice Address - Country:US
Practice Address - Phone:727-799-6255
Practice Address - Fax:813-635-7865
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068773100Medicaid
FL110127089OtherRAILROAD MEDICARE NUMBER
FL068773100Medicaid
D65360Medicare UPIN