Provider Demographics
NPI:1346365269
Name:DITZION, BRUCE R (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:DITZION
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 1:6 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3614
Mailing Address - Country:US
Mailing Address - Phone:617-864-9305
Mailing Address - Fax:
Practice Address - Street 1:6 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-3614
Practice Address - Country:US
Practice Address - Phone:617-864-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine