Provider Demographics
NPI:1750350757
Name:DEOGAYGAY, BERNADETTE A (MD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:A
Last Name:DEOGAYGAY
Suffix:
Gender:F
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:PO BOX 752743
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-2743
Mailing Address - Country:US
Mailing Address - Phone:901-565-0244
Mailing Address - Fax:901-565-0616
Practice Address - Street 1:6490 MOUNT MORIAH ROAD EXT
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-3729
Practice Address - Country:US
Practice Address - Phone:901-565-0244
Practice Address - Fax:901-565-0616
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34588207RN0300X
ARE3210207RN0300X
MS14588207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142433001Medicaid
3416199001OtherCIGNA
TN4030322Medicaid
TN055491Medicaid
TN4030322OtherBLUE CROSS BLUE SHIELD
MS06170061Medicaid
TN114248Medicaid
TN21734Medicaid
AR5M199OtherBLUE CROSS BLUE SHIELD
TN3859242Medicaid
TN21734Medicaid
TN4030322OtherBLUE CROSS BLUE SHIELD
TN4030322Medicaid
MSG12333Medicare UPIN
MS390000125Medicare ID - Type Unspecified
TN3859242Medicare ID - Type Unspecified
TN3859242Medicaid