Provider Demographics
NPI:1316914971
Name:CROFT, BRUCE TREADWELL (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TREADWELL
Last Name:CROFT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-3800
Mailing Address - Country:US
Mailing Address - Phone:508-829-6645
Mailing Address - Fax:508-829-5633
Practice Address - Street 1:795 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-3800
Practice Address - Country:US
Practice Address - Phone:508-829-6645
Practice Address - Fax:508-829-5633
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1563213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001563OtherTUFTS HEALTH PLAN
MA2703028OtherUNITED HEALTH PLAN
MA0339415Medicaid
MA5315OtherFALLON HEALTH PLAN
MA33234OtherHARVARD PILGRIM HEALTH
MA0006147OtherNEIGHBORHOOD HEALTH PLAN
MACRY70670OtherBLUE SHIELD OF MA
MAS009207OtherCHAMPUS
MA001563OtherTUFTS HEALTH PLAN
MA2703028OtherUNITED HEALTH PLAN
MA0006147OtherNEIGHBORHOOD HEALTH PLAN