Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 020490 | CT |
NPI | 1750364972 |
---|---|
Provider Name | Bruce M Mcdonald |
First Address | Boston, MA 02241-5126 |
Second Address | Bridgeport, CT 06610-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 09/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001204908 | (05) | CT |
E31768 | (02) |