MEDICARE: DR. ERIC H BRONSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA66089	NJ
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	44393	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265401566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC H BRONSTEIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2379
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-2379
Country	:	US
Telephone Number	:	606-408-0417
Fax Number	:	606-408-6069

Provider Business Practice Location Address
First Line	:	613 23RD ST
Second Line	:	SUITE 210
City	:	ASHLAND
State	:	KY
Zip	:	41101-2878
Country	:	US
Telephone Number	:	606-326-9847
Fax Number	:	606-326-3418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	06/01/2016

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