Healthcare Provider Details

I. General information

NPI: 1003011669
Provider Name (Legal Business Name): BRUCE DELBERT HUTCHISON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 WOODLAND CIR
ANNAPOLIS MD
21409-5309
US

IV. Provider business mailing address

978 WOODLAND CIR
ANNAPOLIS MD
21409-5309
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-5997
  • Fax:
Mailing address:
  • Phone: 410-757-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: