Provider Demographics
NPI:1750464954
Name:WASLICK, BRUCE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:DAVID
Last Name:WASLICK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:3300 MAIN ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:413-794-5555
Practice Address - Fax:413-794-7140
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA730212084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry