Provider Demographics
NPI:1851453112
Name:ROBINSON-BENNETT, BERNICE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:LOUISE
Last Name:ROBINSON-BENNETT
Suffix:
Gender:F
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 S 5TH AVE
Practice Address - Street 2:N BLDG GROUND FLOOR
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-2143
Practice Address - Country:US
Practice Address - Phone:484-628-8905
Practice Address - Fax:484-628-5189
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9454207V00000X, 207VG0400X
PAMD434857207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102221442Medicaid
TX167902901Medicaid
TXI17369Medicare UPIN
PA102221442Medicaid
TX8C5902Medicare ID - Type Unspecified