Provider Demographics
NPI:1285631267
Name:BRONSTEIN, HERBERT A (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:A
Last Name:BRONSTEIN
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:PO BOX 183027 DEPT LB-05
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3027
Mailing Address - Country:US
Mailing Address - Phone:614-891-0550
Mailing Address - Fax:614-891-0429
Practice Address - Street 1:5877 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2859
Practice Address - Country:US
Practice Address - Phone:614-891-0550
Practice Address - Fax:614-891-0429
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-4253207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203179Medicaid
OHBR0122085Medicare UPIN
OH0203179Medicaid