Provider Demographics
NPI:1588669360
Name:NECKRITZ, BRUCE MAXWELL (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MAXWELL
Last Name:NECKRITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 CENTRAL PKWY E STE 275
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5542
Mailing Address - Country:US
Mailing Address - Phone:972-881-4688
Mailing Address - Fax:972-372-1657
Practice Address - Street 1:10320 LITTLE PATUXENT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3344
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:972-372-1657
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0059310208100000X
FLOS5890208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE49363Medicare UPIN