Provider Demographics
NPI:1669409835
Name:BERNARDO, DANILO R (MD)
Entity type:Individual
Prefix:DR
First Name:DANILO
Middle Name:R
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-535-2111
Mailing Address - Fax:252-535-1295
Practice Address - Street 1:937 GREGORY DRIVE
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-535-2111
Practice Address - Fax:252-935-1295
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33209207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890265VMedicaid
NC7915184Medicaid
NC15184OtherBCBS
NC2310321Medicare ID - Type UnspecifiedGRP
NC15184OtherBCBS
NC890265VMedicaid