Provider Demographics
NPI:1588665590
Name:LOCKMAN, BRUCE EVAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EVAN
Last Name:LOCKMAN
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 1:270 COMMERCE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2405
Mailing Address - Country:US
Mailing Address - Phone:215-646-6868
Mailing Address - Fax:215-646-4422
Practice Address - Street 1:270 COMMERCE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2405
Practice Address - Country:US
Practice Address - Phone:215-646-6868
Practice Address - Fax:215-646-4422
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 021062E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000638673Medicaid
PAB36268Medicare UPIN
PA081041Medicare ID - Type Unspecified