Provider Demographics
NPI:1770787723
Name:BRUCE L. AUERBACH MD LLC
Entity type:Organization
Organization Name:BRUCE L. AUERBACH MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-496-2095
Mailing Address - Street 1:4176 KELNOR DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2959
Mailing Address - Country:US
Mailing Address - Phone:614-317-0022
Mailing Address - Fax:614-317-0015
Practice Address - Street 1:9961 SYLVIAN DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8713
Practice Address - Country:US
Practice Address - Phone:614-496-2095
Practice Address - Fax:614-317-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0624337Medicaid
A16638Medicare UPIN
OH0624337Medicaid