Provider Demographics
NPI:1134489487
Name:BRIDGE, THOMAS PETER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PETER
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921-A LOWER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-9401
Mailing Address - Country:US
Mailing Address - Phone:973-545-6899
Mailing Address - Fax:
Practice Address - Street 1:340 KINGSLAND ST
Practice Address - Street 2:1 4C40
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1150
Practice Address - Country:US
Practice Address - Phone:973-562-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4208022084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry