Healthcare Provider Details

I. General information

NPI: 1164529079
Provider Name (Legal Business Name): BRUCE ALAN HERSHFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 COLD BOTTOM RD
SPARKS MD
21152-9520
US

IV. Provider business mailing address

1415 COLD BOTTOM RD
SPARKS MD
21152-9520
US

V. Phone/Fax

Practice location:
  • Phone: 410-771-4575
  • Fax: 208-694-4107
Mailing address:
  • Phone: 410-771-4575
  • Fax: 208-694-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD16498
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: