Basic Information
| Provider Information | |||||||||
| NPI: | 1003804535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELARDO | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| 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 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 05/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 52031 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 200000650 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 52289 | SC | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | 200000650 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100577000 | 05 | KY | MEDICAID | K271910-KOHMG | 01 | KY | KY MEDICARE | OTHER | N00650 | 05 | SC | MEDICAID | 89126PT | 05 | NC | MEDICAID | 300021125 | 05 | IN | MEDICAID |