Provider Demographics
NPI:1154416907
Name:WELLS, BRUCE C (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6221 SYKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-795-5131
Mailing Address - Fax:410-795-5100
Practice Address - Street 1:6221 SYKESVILLE RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784
Practice Address - Country:US
Practice Address - Phone:410-795-5131
Practice Address - Fax:410-795-5100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD14139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14139Medicare UPIN