Provider Demographics
NPI:1134748478
Name:BERNING, ANNA BISTLINE (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BISTLINE
Last Name:BERNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:K
Other - Last Name:BISTLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3518 FORT ROBERDEAU AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3222
Mailing Address - Country:US
Mailing Address - Phone:814-931-9978
Mailing Address - Fax:814-943-1808
Practice Address - Street 1:1101 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4029
Practice Address - Country:US
Practice Address - Phone:814-943-9879
Practice Address - Fax:814-943-1808
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD484330207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program