Provider Demographics
NPI:1396745394
Name:GARBER, BRUCE BART (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BART
Last Name:GARBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-0686
Mailing Address - Country:US
Mailing Address - Phone:610-613-9251
Mailing Address - Fax:215-247-3085
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-247-3082
Practice Address - Fax:215-247-3085
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025287E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080158Medicare PIN
PAC29230Medicare UPIN