Provider Demographics
NPI:1609395813
Name:BERNAL, MARCELA (PA-C)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 FIELDSTONE
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1251
Mailing Address - Country:US
Mailing Address - Phone:305-331-5583
Mailing Address - Fax:
Practice Address - Street 1:407 FIELDSTONE
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1251
Practice Address - Country:US
Practice Address - Phone:305-331-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4334OtherCONNETICUT DEPARTMENT OF HEALTH
RIPA01664OtherRI DEPARTMENT OF HEALTH