Provider Demographics
NPI:1245311166
Name:KARLIN, BRUCE GARDNER (MD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:GARDNER
Last Name:KARLIN
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 LINCOLN STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-755-1222
Mailing Address - Fax:508-754-7020
Practice Address - Street 1:108 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2651
Practice Address - Country:US
Practice Address - Phone:508-453-1005
Practice Address - Fax:508-749-0295
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10275OtherBLUE CROSS
MA3085317Medicaid
MA64275OtherHARVARD
MAJ10275Medicare ID - Type Unspecified
MA3085317Medicaid