Basic Information
| Provider Information | |||||||||
| NPI: | 1598114720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | ETHAN | ||||||||
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| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVAL MEDICAL CTR | ||||||||
| Address2: | 34800 BOB WILSON DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921345000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326827 | ||||||||
| FaxNumber: | 6195327508 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 50, FARENHOLT AVE | ||||||||
| Address2: | |||||||||
| City: | AGANA HEIGHTS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 96910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6713449340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2016 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 207X00000X | 30182 | NE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.