Provider Demographics
NPI:1144226523
Name:MARKOVITZ, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:MARKOVITZ
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 1:413 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1816
Mailing Address - Country:US
Mailing Address - Phone:610-825-8210
Mailing Address - Fax:610-825-8208
Practice Address - Street 1:413 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1816
Practice Address - Country:US
Practice Address - Phone:610-825-8210
Practice Address - Fax:610-825-8208
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051757L207W00000X
NJ25MA05816900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6830706Medicaid
PA0387854000OtherINDEPENDENCE BLUE CROSS
PA3800663OtherCIGNA
NJ01000268100OtherAMEERICHOICE
NJ0523259000OtherAMERIHEALTH
NJ1078293OtherHORIZON NJ HEALTH
NJ5757360OtherAETNA
PA00056438OtherHIGHMARK BS
PAG21733Medicare UPIN
NJ5757360OtherAETNA
NJ688596Medicare PIN