Provider Demographics
NPI:1396786554
Name:BRUCK, KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4124
Mailing Address - Country:US
Mailing Address - Phone:413-395-7572
Mailing Address - Fax:413-553-6760
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6502
Practice Address - Country:US
Practice Address - Phone:413-442-1019
Practice Address - Fax:413-447-8521
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
201300OtherMED A BHMH
20Z300OtherMEDICARE A BHMH SWING BED
102380100OtherMEDICAID BHMH
200051OtherMEDICARE B BHMH
AA105016OtherHARVARD PILGRIM
SX3479OtherMED B BHMH
061408OtherANTHEM
7243065OtherAETNA HMO
102380100OtherMEDICAID BHMH
MEMM911002Medicare PIN
MM9110Medicare PIN
SX3479OtherMED B BHMH