Provider Demographics
NPI:1093864431
Name:MERHIGE, BRUCE ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALAN
Last Name:MERHIGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH STREET
Mailing Address - Street 2:SUITE 1707
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6217
Mailing Address - Country:US
Mailing Address - Phone:215-546-2556
Mailing Address - Fax:215-546-2556
Practice Address - Street 1:255 S 17TH STREET
Practice Address - Street 2:SUITE 1707
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6217
Practice Address - Country:US
Practice Address - Phone:215-546-2556
Practice Address - Fax:215-546-2556
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002100L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413985Medicare UPIN
PAME413985Medicare ID - Type Unspecified