Provider Demographics
NPI:1174548499
Name:SIMONS, BERNIE M (MD)
Entity type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:M
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BANKSVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2718
Mailing Address - Country:US
Mailing Address - Phone:412-941-0702
Mailing Address - Fax:412-942-0733
Practice Address - Street 1:3005 BANKSVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2718
Practice Address - Country:US
Practice Address - Phone:412-941-0702
Practice Address - Fax:412-942-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049102L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001448637Medicaid
PA149486Medicare ID - Type Unspecified
PA0014486370012Medicaid