Provider Demographics
NPI:1821047895
Name:BERNING, ERIC LEE (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:BERNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:6TH FLOOR, SUPPORT TOWER
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-8911
Practice Address - Fax:864-455-8368
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC277772080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCAPPROVEDMedicaid
SC57-6007863054OtherBLUE CHOICE OF SC
SC277774Medicaid
SC5424661OtherAETNA
SCH134653640Medicare PIN
SCH134657951Medicare PIN
SC4636523OtherCIGNA