Provider Demographics
NPI:1669449880
Name:BRUDER, DANIELLE C (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:C
Last Name:BRUDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1107
Mailing Address - Country:US
Mailing Address - Phone:610-495-8300
Mailing Address - Fax:610-495-1017
Practice Address - Street 1:1030 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINFIELD
Practice Address - State:PA
Practice Address - Zip Code:19468-1107
Practice Address - Country:US
Practice Address - Phone:610-495-8300
Practice Address - Fax:610-495-1017
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060075L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine