Individual
AMIR BERNABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 BREWSTER ST, PAWTUCKET, RI 02860-4400
(401) 729-2419
(401) 729-2517
Mailing address
111 BREWSTER ST, WOOD BLDG #516, PAWTUCKET, RI 02860-4400
(401) 729-3481
(401) 729-2721
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD12956
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001119601
MEDICARE PTAN
RI
05
—
110087756A
—
MA
05
—
AB76065
—
RI
Enumeration date
05/07/2007
Last updated
09/12/2011
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