Provider Demographics
NPI:1952366411
Name:DAVIDSON, BRUCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:DAVIDSON
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 1:67 UNION ST
Mailing Address - Street 2:METROWEST MEDICAL CENTER
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-650-7304
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:METROWEST MEDICAL CENTER
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37062207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6179568Medicaid
MAJ02738Medicare ID - Type Unspecified
MA6179568Medicaid