Provider Demographics
NPI:1174552012
Name:KINZINGER, BRUCE C (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:KINZINGER
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:995 HOSPITALITY WAY
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1755
Practice Address - Country:US
Practice Address - Phone:410-306-7880
Practice Address - Fax:410-306-7881
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418799207Q00000X
MDD0044260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001890267Medicaid
MD207610ZDDBMedicare PIN
PA080182931Medicare PIN
MD207610YVZMedicare PIN
PA055995Medicare PIN
PA001890267Medicaid
PAF62489Medicare UPIN
PA080182931Medicare PIN
PA73646OtherGEISINGER
PA001890267Medicaid
MD207610YVZ-945LMedicare PIN