Provider Demographics
NPI:1770795734
Name:BERNSTEIN, MARK HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:BERNSTEIN
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 1:59-544 AKANOHO PL
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9501
Mailing Address - Country:US
Mailing Address - Phone:808-674-2930
Mailing Address - Fax:808-674-2950
Practice Address - Street 1:599 FARRINGTON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2001
Practice Address - Country:US
Practice Address - Phone:808-674-2930
Practice Address - Fax:808-674-2950
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-39822084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56336Medicare ID - Type Unspecified