Provider Demographics
NPI:1649264698
Name:HARRO, BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:HARRO
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 1:92 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1301
Mailing Address - Country:US
Mailing Address - Phone:518-695-5137
Mailing Address - Fax:518-695-5149
Practice Address - Street 1:92 BROAD ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1301
Practice Address - Country:US
Practice Address - Phone:518-695-5137
Practice Address - Fax:518-695-5149
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28124Medicare UPIN
55820BMedicare ID - Type Unspecified