Provider Demographics
NPI:1528053667
Name:BERNHISEL, MARC A (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:BERNHISEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5245 E FLETCHER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1126
Mailing Address - Country:US
Mailing Address - Phone:813-914-7304
Mailing Address - Fax:813-676-8838
Practice Address - Street 1:5245 E FLETCHER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1126
Practice Address - Country:US
Practice Address - Phone:813-914-7304
Practice Address - Fax:813-676-8838
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME47242207VE0102X
UT165085-1205207VE0102X
NC27121207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C82805Medicare UPIN
FL0047242Medicare ID - Type Unspecified