Healthcare Provider Details

I. General information

NPI: 1225084981
Provider Name (Legal Business Name): STEPHANIE BRUCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW SUITE 2A38
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

100 IRVING ST NW SUITE EB3114, EAST BUILDING
WASHINGTON DC
20010-3017
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-0570
  • Fax:
Mailing address:
  • Phone: 202-877-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD034927
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: