Provider Demographics
NPI:1922062389
Name:WINTMAN, BRUCE I (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:I
Last Name:WINTMAN
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 1:3550 MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1086
Mailing Address - Country:US
Mailing Address - Phone:413-733-2204
Mailing Address - Fax:413-734-0587
Practice Address - Street 1:3550 MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1086
Practice Address - Country:US
Practice Address - Phone:413-733-2204
Practice Address - Fax:413-734-0587
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151649207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
172409OtherHARVARD PILGRIM
704900OtherCONNECTICARE
000000006046OtherBOSTON HEALTHNET
3102816005OtherCIGNA
26365OtherHNE
MAJ18367OtherBCBS HMO
J18367OtherBCBS OUT OF STATE
151649OtherTUFTS
MAJ18367OtherBCBS PPO
A22538Medicare ID - Type Unspecified
000000006046OtherBOSTON HEALTHNET
MAJ18367OtherBCBS HMO
151649OtherTUFTS