Provider Demographics
NPI:1962664706
Name:BERNARDO, EDSELL CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDSELL
Middle Name:CARLOS
Last Name:BERNARDO
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 1:46 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2924
Mailing Address - Country:US
Mailing Address - Phone:401-596-0174
Mailing Address - Fax:401-596-2266
Practice Address - Street 1:46 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2924
Practice Address - Country:US
Practice Address - Phone:401-596-0174
Practice Address - Fax:401-596-2266
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI12727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3V4135OtherHEALTH NET
RIEB75465Medicaid
RI010012727RI01OtherANTHEM
CT53205OtherCONNECTICARE
RI007060571Medicare PIN