Provider Demographics
NPI:1346212412
Name:BRIDENBAUGH, GEORGE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALAN
Last Name:BRIDENBAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:310 STOCK ST
Mailing Address - Street 2:STE 3
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-637-1738
Mailing Address - Fax:717-637-3044
Practice Address - Street 1:310 STOCK ST
Practice Address - Street 2:STE 3
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-637-1738
Practice Address - Fax:717-637-3044
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAM2023696E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009470420004Medicaid
PA053119ZEA5Medicare PIN
B34460Medicare UPIN