Provider Demographics
NPI:1912904137
Name:BERNAL, GUILLERMO JOSE (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:JOSE
Last Name:BERNAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:770 NEWTOWN YARDLEY RD 225
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4501
Mailing Address - Country:US
Mailing Address - Phone:215-968-4901
Mailing Address - Fax:215-968-9718
Practice Address - Street 1:770 NEWTOWN YARDLEY RD 225
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4501
Practice Address - Country:US
Practice Address - Phone:215-968-4901
Practice Address - Fax:215-968-9718
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045552E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
23191OtherAETNA HMO
BUS107OtherOXFORD
269999OtherMAMSI
BE618804OtherHIGHMARK BLUE SHIELD
250004597OtherMEDICARE RAILROAD
0447984000OtherINDEPENDENCE BLUE CROSS
618804OtherINDEPENDENCE BLUE CROSS
4272117OtherAETNA NON HMO
PO28471OtherCHAMPUS/TRICARE
BUS107OtherOXFORD
BE618804OtherHIGHMARK BLUE SHIELD