Provider Demographics
NPI:1376562447
Name:KRIEGEL, BRUCE J (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:KRIEGEL
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 1:830 OAK ST.
Mailing Address - Street 2:SUITE 205W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-583-4440
Mailing Address - Fax:508-583-7401
Practice Address - Street 1:830 OAK ST.
Practice Address - Street 2:SUITE 205W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-4440
Practice Address - Fax:508-583-7401
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54434207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3006166Medicaid
MDA58314Medicare UPIN
MA3006166Medicaid