Provider Demographics
NPI:1770571572
Name:WALKER, BRUCE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:WALKER
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 1:400 TECHNOLOGY SQ
Mailing Address - Street 2:ROOM 870
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3583
Mailing Address - Country:US
Mailing Address - Phone:857-268-7072
Mailing Address - Fax:
Practice Address - Street 1:400 TECHNOLOGY SQ
Practice Address - Street 2:ROOM 870
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3583
Practice Address - Country:US
Practice Address - Phone:857-268-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49648207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16279OtherPROVIDER CODE MGH
MA3350987-001OtherCIGNA PAL
MA049648OtherTUFTS
MA6191924Medicaid
MA4647796OtherAETNA
MA9204113OtherUNITED-PBO
MAJ04403OtherBCBS
MAD82893075MGHOtherHPHC-PBO
MAD82893MGHOtherHPHC-ACD
MAJ04403Medicare ID - Type Unspecified
MAD82893MGHOtherHPHC-ACD