Healthcare Provider Details

I. General information

NPI: 1265401566
Provider Name (Legal Business Name): ERIC H BRONSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST SUITE 210
ASHLAND KY
41101-2878
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-9847
  • Fax: 606-326-3418
Mailing address:
  • Phone: 606-408-0417
  • Fax: 606-408-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA66089
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number44393
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: