Provider Demographics
NPI:1891750048
Name:BERNAL, W PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:W PATRICK
Middle Name:
Last Name:BERNAL
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 1:125 LATTIMORE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4159
Mailing Address - Country:US
Mailing Address - Phone:585-461-5940
Mailing Address - Fax:585-242-0682
Practice Address - Street 1:125 LATTIMORE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-461-5940
Practice Address - Fax:585-242-0682
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE41038Medicare UPIN
NY16413MMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION