Provider Demographics
NPI:1760478770
Name:BRONSTEIN, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BRONSTEIN
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 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3122
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:5 ALICE PECK DAY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2901
Practice Address - Country:US
Practice Address - Phone:603-448-3122
Practice Address - Fax:603-448-7491
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE10790OtherHARVARD PILGRIM
NH30002406Medicaid
VT1002887Medicaid
08P072OtherMVP
VT1002887Medicaid
NHE10790Medicare UPIN