Individual
BRUCE C WASKOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
770 BROAD STRET, EAST EARL, PA 17519
(717) 445-4576
(717) 445-4483
Mailing address
PO BOX 130, TERRE HILL, PA 17581-0130
(717) 445-4576
(717) 445-4483
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD043260L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012519450003
—
PA
01
—
50051166
CAPITAL BLUE
PA
01
—
574317
AETNA
PA
01
—
679064
BLUE SHIELD
PA
01
—
P002394
GATEWAY
PA
01
—
P00259886
RR MCR
PA
Enumeration date
08/01/2006
Last updated
03/09/2012
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