Provider Demographics
NPI:1780750406
Name:BERNSTEIN, RICHARD IRA (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:IRA
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 1:900 SOUTH ELISEO DR
Mailing Address - Street 2:#201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-461-1780
Mailing Address - Fax:415-461-7378
Practice Address - Street 1:900 SOUTH ELISEO DR
Practice Address - Street 2:#201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-461-1780
Practice Address - Fax:415-461-7378
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG179390207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA460001947OtherRR
CA00G179390Medicare ID - Type Unspecified
A40231Medicare UPIN