Provider Demographics
NPI:1295718534
Name:BERNING, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BERNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:A
Other - Last Name:BERNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 CHURCH HILL RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1108
Mailing Address - Country:US
Mailing Address - Phone:203-426-0225
Mailing Address - Fax:203-426-0249
Practice Address - Street 1:107 CHURCH HILL RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1108
Practice Address - Country:US
Practice Address - Phone:203-426-0225
Practice Address - Fax:203-426-0249
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0349592080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001349598Medicaid
F24187Medicare UPIN