Provider Demographics
NPI:1821068107
Name:SUMLIN, BRUCE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAMES
Last Name:SUMLIN
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 1:200 BANNING ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-678-1700
Mailing Address - Fax:302-678-2330
Practice Address - Street 1:6418 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2308
Practice Address - Country:US
Practice Address - Phone:410-318-8855
Practice Address - Fax:410-764-3229
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454657207W00000X
DEC1-0008619207W00000X
MDD0067113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDR0006276OtherCDS #
11809122OtherCAQH
MDM94008OtherCDS
MDM94008OtherCDS
DEBS4051392OtherDEA#
DE1821068107Medicaid
11809122OtherCAQH