Provider Demographics
NPI:1164529079
Name:HERSHFIELD, BRUCE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:HERSHFIELD
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 1:1415 COLD BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9520
Mailing Address - Country:US
Mailing Address - Phone:410-771-4575
Mailing Address - Fax:208-694-4107
Practice Address - Street 1:1415 COLD BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9520
Practice Address - Country:US
Practice Address - Phone:410-771-4575
Practice Address - Fax:208-694-4107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD164982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB67258Medicare UPIN