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General NPI Number Information
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NPI Number | 1578743399
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Entity Type | Organization
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Legal Business Name | BRUCE L REGAN, MD CHARTERED
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 405 FREDERICK RD SUITE 263
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City | BALTIMORE
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State | MD
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Zip | 21228-4645
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Country | US
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Telephone | 410-747-6106
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Fax | 410-747-5601
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Provider Business Mailing Address
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Address Line | 405 FREDERICK RD SUITE 263
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City | BALTIMORE
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State | MD
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Zip | 21228-4645
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Country | US
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Telephone | 410-747-6106
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Fax | 410-747-5601
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Authorized Official
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Title or Position | PRERSIDENT
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Name | DR. BRUCE LINTHICUM REGAN
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Credential | M. D.
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Telephone | 410-747-6106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | D0018610
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License Number State | MD
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