Provider Demographics
NPI:1609187665
Name:BRUCE HOPPER JR MD LLC
Entity Type:Organization
Organization Name:BRUCE HOPPER JR MD LLC
Other - Org Name:HOPMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-575-5085
Mailing Address - Street 1:1618 SOUTH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1542
Mailing Address - Country:US
Mailing Address - Phone:215-575-5085
Mailing Address - Fax:215-278-2965
Practice Address - Street 1:1618 SOUTH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1542
Practice Address - Country:US
Practice Address - Phone:215-575-5085
Practice Address - Fax:215-278-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421377261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care