Provider Demographics
NPI:1750380077
Name:BARLAM, BRUCE W (MD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:W
Last Name:BARLAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2100
Mailing Address - Country:US
Mailing Address - Phone:978-740-0406
Mailing Address - Fax:978-740-3012
Practice Address - Street 1:55 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 203B
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2100
Practice Address - Country:US
Practice Address - Phone:978-740-0406
Practice Address - Fax:978-740-3012
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2016-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA73684208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3075923Medicaid
MA3075923Medicaid
MAJ10668Medicare ID - Type Unspecified