Provider Demographics
NPI:1710121967
Name:BISTRONG, HERBERT W (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:W
Last Name:BISTRONG
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 1:8 SCHOONER RDG
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1570
Mailing Address - Country:US
Mailing Address - Phone:978-282-3219
Mailing Address - Fax:
Practice Address - Street 1:8 SCHOONER RDG
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1570
Practice Address - Country:US
Practice Address - Phone:978-282-3219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine