Basic Information
Provider Information
NPI: 1003804535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VELARDO
FirstName: BERNARD
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 751461
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282751461
CountryCode: US
TelephoneNumber: 8437926200
FaxNumber: 7043773389
Practice Location
Address1: 171 ASHLEY AVE
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294255812
CountryCode: US
TelephoneNumber: 8437921414
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/10/2005
LastUpdateDate: 05/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X52289SCY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X200000650NCN Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X52031KYN Allopathic & Osteopathic PhysiciansAnesthesiology 
207LC0200X200000650NCN Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

ID Information
IDTypeStateIssuerDescription
710057700005KY MEDICAID
89126PT05NC MEDICAID
N0065005SC MEDICAID
K271910-KOHMG01KYKY MEDICAREOTHER
30002112505IN MEDICAID


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