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1437150596

NPI Code Detail

MEDICARE: DR. TYRONE GARY BRISTOL M.D.

MEDICARE: DR. TYRONE GARY BRISTOL 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	208000000X	Pediatrics Physician	MD053658L	PA
2	208000000X	Pediatrics Physician	2013-02294	NC
3	208000000X	Pediatrics Physician	198984	NY
4	2084P0800X	Psychiatry Physician	11658	GA
5	2084P0804X	Child & Adolescent Psychiatry Physician	MD053658L	PA
6	2084P0800X	Psychiatry Physician	MD053658L	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437150596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYRONE GARY BRISTOL M.D.

Provider Business Mailing Address
First Line	:	802 NEW HOLLAND AVE STE 100
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2288
Country	:	US
Telephone Number	:	717-560-3782
Fax Number	:	717-560-3787

Provider Business Practice Location Address
First Line	:	802 NEW HOLLAND AVE STE 100
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2288
Country	:	US
Telephone Number	:	717-560-3782
Fax Number	:	717-560-3787

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/12/2023

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Directions to “ DR. TYRONE GARY BRISTOL M.D.” Practice Location

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