Provider Demographics
NPI:1770576019
Name:LANTELME, BRUCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:LANTELME
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3288 ROBINHOOD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5464
Mailing Address - Country:US
Mailing Address - Phone:336-768-3335
Mailing Address - Fax:336-768-4171
Practice Address - Street 1:3288 ROBINHOOD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-768-3335
Practice Address - Fax:336-768-4171
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC96 01654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC96-01654Medicaid
2233954Medicare ID - Type Unspecified
NC96-01654Medicaid