Provider Demographics
NPI:1073739421
Name:BRUCE A HERSHOCK MD LTD
Entity Type:Organization
Organization Name:BRUCE A HERSHOCK MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERSHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-539-3233
Mailing Address - Street 1:1010 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650
Mailing Address - Country:US
Mailing Address - Phone:724-539-3233
Mailing Address - Fax:724-539-0069
Practice Address - Street 1:1010 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-539-3233
Practice Address - Fax:724-539-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA016893E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006164150001Medicaid
1508226OtherBS
1003809OtherGATEWAY
PA0006164150001Medicaid
140056Medicare ID - Type Unspecified