Bernard Lee Pahl
Individual provider Active NPI Contractor · Vincent, OH
NPI 1700488608 · NPPES record last updated Nov 15, 2020
Key facts
- NPI
- 1700488608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- WV001686 (WV)
- Practice address
- 771 Brackenridge Rd
Vincent, OH 45784-5028 - Phone
- (740) 350-8184
- NPI assigned
- Nov 15, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WV001686 | WV | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | WV001686 | WV | Yes |
Addresses
Primary practice location
771 Brackenridge Rd
Vincent, OH 45784-5028
Mailing address
771 Brackenridge Rd
Vincent, OH 45784-5028
Phone (740) 350-8184
Other providers in Vincent, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.