Provider Demographics
NPI:1366462640
Name:FLAX, BRUCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:FLAX
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 1:400 CAMPUS BLVD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:540-450-2787
Practice Address - Street 1:400 CAMPUS BLVD.
Practice Address - Street 2:SUITE 110
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:540-722-2635
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010458582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7221690Medicaid
WV7221690Medicaid
F48479Medicare UPIN
VA7221690Medicaid