Provider Demographics
NPI:1194798173
Name:KING, BRUCE E (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:KING
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065935L246Q00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA220025955OtherRR MEDICARE
PA50056060OtherCAPITAL BLUE CROSS & KEYSTONE HEALTH PLAN CENTRAL
PA53372OtherGEISINGER
PA2059148000OtherINDEPENDENCE BLUE CROSS
PA1150134OtherAETNA-HMO
PA20010382OtherMERCY
PA001366965OtherHIGHMARK
PA001757104Medicaid
PA30002667OtherKEYSTONE MERCY
PA000000126590OtherUNISON
PA7860804OtherAETNA-NON HMO
PA30002667OtherKEYSTONE MERCY
PA032338Medicare ID - Type Unspecified