MEDICARE: BRUCE EVAN LOCKMAN 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	MD 021062E	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

General Provider Information

NPI Number	:	1588665590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE EVAN LOCKMAN M.D.

Provider Business Mailing Address
First Line	:	270 COMMERCE DR
Second Line	:	SUITE 250
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2405
Country	:	US
Telephone Number	:	215-646-6868
Fax Number	:	215-646-4422

Provider Business Practice Location Address
First Line	:	270 COMMERCE DR
Second Line	:	SUITE 250
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2405
Country	:	US
Telephone Number	:	215-646-6868
Fax Number	:	215-646-4422

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	06/21/2016

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