Provider Demographics
NPI:1831185032
Name:MACLEOD, BRUCE A (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:MACLEOD
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 1:1515 MOHICAN DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1615
Mailing Address - Country:US
Mailing Address - Phone:412-849-3671
Mailing Address - Fax:412-232-5768
Practice Address - Street 1:3290 SAW MILL RUN BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:PA
Practice Address - Zip Code:15227-2318
Practice Address - Country:US
Practice Address - Phone:412-437-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD23896207P00000X
PAMD044492E207P00000X
OH35.136706207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011895170001Medicaid
PA1513379OtherGATEWAY
PA250350OtherUPMC
PA0505638OtherAETNA PVN
PA567777JK6OtherPA MCR GROUP PTAN
PA930009485OtherRR MEDICARE
PA62746OtherUNISON
PA594424OtherBCBS
PA5608033OtherAETNA PIN
PA62746OtherUNISON
PA594424JK6Medicare ID - Type Unspecified