Healthcare Provider Details

I. General information

NPI: 1396745394
Provider Name (Legal Business Name): BRUCE BART GARBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 03/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JAMESTOWN ST SUITE 108
PHILADELPHIA PA
19128-1751
US

IV. Provider business mailing address

PO BOX 686
BRYN MAWR PA
19010-0686
US

V. Phone/Fax

Practice location:
  • Phone: 215-247-3082
  • Fax: 215-247-3085
Mailing address:
  • Phone: 610-613-9251
  • Fax: 215-247-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD025287E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: