Provider Demographics
NPI:1295964971
Name:BERNARD, JOHNATHAN ALEXANDER (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:ALEXANDER
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 75868
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-4095
Mailing Address - Country:US
Mailing Address - Phone:703-810-5204
Mailing Address - Fax:703-810-5411
Practice Address - Street 1:24600 MILLSTREAM DRIVE
Practice Address - Street 2:SUITE 380
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5686
Practice Address - Country:US
Practice Address - Phone:703-810-5241
Practice Address - Fax:571-407-5689
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258391207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN/AOtherUNLICENSED MEDICAL PRACITIONER