Provider Demographics
NPI:1356544183
Name:GENTER, BRUCE ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ERIC
Last Name:GENTER
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 1:422 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7812
Mailing Address - Country:US
Mailing Address - Phone:215-450-7744
Mailing Address - Fax:
Practice Address - Street 1:422 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-7812
Practice Address - Country:US
Practice Address - Phone:215-450-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030763-E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0990778Medicaid
PAGE108532Medicare ID - Type Unspecified
PAB37070Medicare UPIN