Provider Demographics
NPI:1730212838
Name:BERNARDI, DIANE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BERNARDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 FALLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7147
Mailing Address - Country:US
Mailing Address - Phone:260-436-8000
Mailing Address - Fax:260-432-5587
Practice Address - Street 1:5750 FALLS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7147
Practice Address - Country:US
Practice Address - Phone:260-436-8000
Practice Address - Fax:260-432-5587
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3568238207N00000X
IN01052974A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070015104OtherRAILROAD
OH138621Medicaid
OH138621Medicaid
OH0787734Medicare PIN