Healthcare Provider Details

I. General information

NPI: 1275238073
Provider Name (Legal Business Name): MARTIN HARRINGTON BRONSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 NEW GARDEN RD
GREENSBORO NC
27410-2721
US

IV. Provider business mailing address

1210 NEW GARDEN RD
GREENSBORO NC
27410-2721
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-6190
  • Fax:
Mailing address:
  • Phone: 336-294-6190
  • Fax: 336-294-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202600209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: