Individual
MRS. ELIZABETH JANE BRUCHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
9105 FRANKLIN SQUARE DR, SUITE 209, BALTIMORE, MD 21237-3930
(410) 602-9262
(410) 602-9276
Mailing address
1838 GREENE TREE RD, SUITE 150 LL, BALTIMORE, MD 21208-6391
(410) 602-9262
(410) 602-9276
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0004030
MD
363AM0700X
Medical Physician Assistant
4756
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168403YUT
MEDICARE
MD
Enumeration date
05/12/2006
Last updated
08/23/2010
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