Provider Demographics
NPI:1205893344
Name:CHAMOVITZ, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:CHAMOVITZ
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 1:99 AUTUMN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1301
Mailing Address - Country:US
Mailing Address - Phone:724-375-3199
Mailing Address - Fax:724-375-5858
Practice Address - Street 1:99 AUTUMN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1301
Practice Address - Country:US
Practice Address - Phone:724-375-3199
Practice Address - Fax:724-375-5858
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027359E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA206098OtherUPMC
OH0708550Medicaid
PA0009505850002Medicaid
PA174451OtherBLUE SHIELD
010007069Medicare PIN
PA174451Medicare PIN
PA206098OtherUPMC
PAB40659Medicare UPIN
PA174451OtherBLUE SHIELD