1194798173 NPI number — BRUCE E KING M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194798173 NPI number — BRUCE E KING M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KING

Provider First Name:

BRUCE

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1194798173

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/28/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

555 N DUKE ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LANCASTER

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17602-2250

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-544-5511

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

555 N DUKE ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LANCASTER

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17602-2250

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-544-5511

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

02/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 246Q00000X , with the licence number:  MD065935L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207ZP0102X , with the licence number: MD065935L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 220025955 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50056060 . This is a "CAPITAL BLUE CROSS & KEYSTONE HEALTH PLAN CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 53372 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2059148000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1150134 . This is a "AETNA-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 20010382 . This is a "MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 001366965 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 001757104 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 30002667 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 000000126590 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7860804 . This is a "AETNA-NON HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".