Provider Demographics
NPI:1588845432
Name:BRUCE C. WINNACOTT M.D., P.A.
Entity Type:Organization
Organization Name:BRUCE C. WINNACOTT M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WINNACOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-742-3112
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-742-3112
Mailing Address - Fax:410-742-4547
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 701
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:410-742-3112
Practice Address - Fax:410-742-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ066Medicare PIN