Provider Demographics
NPI:1942542675
Name:CAMBOSOS, BRUCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:CAMBOSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:MICHAEL
Other - Last Name:CAMBOSOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6511 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2621
Mailing Address - Country:US
Mailing Address - Phone:202-291-8575
Mailing Address - Fax:
Practice Address - Street 1:6511 7TH STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD63792084F0202X
VA01010207462084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry