MEDICARE: BRUCE HOPPER JR MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD421377	PA

General Provider Information

NPI Number	:	1609187665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE HOPPER JR MD LLC

Provider Business Mailing Address
First Line	:	1618 SOUTH ST
Second Line	:	GROUND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1542
Country	:	US
Telephone Number	:	215-575-5085
Fax Number	:	215-278-2965

Provider Business Practice Location Address
First Line	:	1618 SOUTH ST
Second Line	:	GROUND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1542
Country	:	US
Telephone Number	:	215-575-5085
Fax Number	:	215-278-2965

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. BRUCE DONALD HOPPER JR.
Credential	:	MD
Telephone Number	:	215-575-5085

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	07/27/2016

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