Provider Demographics
NPI:1861430985
Name:KING, BERNARD F (DO)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:F
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1365
Mailing Address - Country:US
Mailing Address - Phone:484-227-7790
Mailing Address - Fax:484-227-7791
Practice Address - Street 1:1020 BALTIMORE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1365
Practice Address - Country:US
Practice Address - Phone:484-227-7790
Practice Address - Fax:484-227-7791
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007448L207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF46774Medicare UPIN
DE445017OtherMEDICARE PTAN