Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 74392 | MA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 74392 | MA |
NPI | 1215091905 |
---|---|
Provider Name | Raffaele Bruno |
First Address | Burlington, MA 01805-0001 |
Second Address | Burlington, MA 01805-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 21/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3081176 | (05) | MA |
E93287 | (02) | MA |