Provider Demographics
NPI:1922080290
Name:BERNHARD, LARRY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MICHAEL
Last Name:BERNHARD
Suffix:
Gender:M
Credentials:DPM
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 452
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-0452
Mailing Address - Country:US
Mailing Address - Phone:410-960-3084
Mailing Address - Fax:410-349-9818
Practice Address - Street 1:446 COLONIAL RIDGE LN
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2390
Practice Address - Country:US
Practice Address - Phone:410-960-3084
Practice Address - Fax:410-349-9818
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00591213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59860Medicare UPIN
G01713C0LMedicare ID - Type Unspecified
001N829FMedicare ID - Type UnspecifiedOCIN
G9713Medicare ID - Type Unspecified