Healthcare Provider Details

I. General information

NPI: 1932172269
Provider Name (Legal Business Name): BRUCE A BROD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 CROOKED OAK DR SUITE 200
LANCASTER PA
17601
US

IV. Provider business mailing address

500 UNIVERSITY DRIVE
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-3279
  • Fax: 717-569-2187
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-042137-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: