Provider Demographics
NPI:1134150667
Name:BUSHWICK, BRUCE MICAH (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICAH
Last Name:BUSHWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-851-3535
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:BLDG MKB
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-851-3535
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029583E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01703502OtherCAPITAL BLUE CROSS-YH
PA001095653Medicaid
MD615811OtherCAREFIRST MD BCBS
PA080143004OtherRAILROAD MEDICARE
PA80778OtherUNISON-YH
PA186188OtherHIGHMARK BLUE SHIELD
PA251598OtherMAMSI-YH
PAP003057OtherGATEWAY-YH
PA16025OtherJOHNS HOPKINS
PA20005827OtherAMERIHEALTH MERCY-YH
PA35428OtherGEISINGER
PA5919136OtherAETNA
PAP003057OtherGATEWAY-YH
PAB40888Medicare UPIN