Provider Demographics
NPI:1396856175
Name:CERNE, CONNIE D (PAC)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:D
Last Name:CERNE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:D
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:2325 STANTONSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-752-5156
Mailing Address - Fax:252-752-0399
Practice Address - Street 1:2325 STANTONSBURG ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-752-5156
Practice Address - Fax:252-752-0399
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103095207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947057Medicaid
P10983Medicare UPIN
NC2752905Medicare ID - Type Unspecified
2752905Medicare PIN