Basic Information
| Provider Information | |||||||||
| NPI: | 1356303481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNACKI | ||||||||
| FirstName: | BRAD | ||||||||
| MiddleName: | LANG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 NEWARK GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430239142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407889220 | ||||||||
| FaxNumber: | 7407889226 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 NEWARK GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | GRANVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430239142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407889220 | ||||||||
| FaxNumber: | 7407889226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 04/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35084760 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.