Fred G Bromberg, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA03626400 Issued in NJ

Practice address

Wake Forest Baptist Medical Ctr
Medical Center Blvd, Care Coordination Dept
Winston Salem, NC 27157

Phone

(336) 716-7964

Fax

(336) 716-9338

NPI assigned

Feb 9, 2007

Last updated

Dec 14, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1851432967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W 4TH ST",
            "address_2": "APT 1802",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012944",
            "telephone_number": "336-448-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WAKE FOREST BAPTIST MEDICAL CTR",
            "address_2": "MEDICAL CENTER BLVD, CARE COORDINATION DEPT",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27157",
            "telephone_number": "336-716-7964",
            "fax_number": "336-716-9338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROMBERG",
        "first_name": "FRED",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA03626400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6503101",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.