Provider Demographics
NPI:1205883113
Name:BERNARDINI, HOLLY LAYMAN (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LAYMAN
Last Name:BERNARDINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 PARK CEDAR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8701
Mailing Address - Country:US
Mailing Address - Phone:704-438-9383
Mailing Address - Fax:704-799-7812
Practice Address - Street 1:10021 PARK CEDAR DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8701
Practice Address - Country:US
Practice Address - Phone:704-438-9383
Practice Address - Fax:704-799-7812
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205883113Medicaid
NC891377GMedicaid
NC1205883113Medicaid
NCNC9234AMedicare PIN
NC2402336Medicare PIN
NC891377GMedicaid