Provider Demographics
NPI:1306815105
Name:WARD, BRUCE HORATIO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HORATIO
Last Name:WARD
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 1:505 W LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-562-2769
Mailing Address - Fax:804-269-3406
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-788-0004
Practice Address - Fax:804-788-0120
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034738174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306815105Medicaid
VA6023827Medicaid
VA1306815105Medicaid
VA060000202Medicare ID - Type Unspecified