Basic Information
Provider Information
NPI: 1326059916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUGNARA
FirstName: CARLO
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 LONGWOOD AVE
Address2:  
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556000
FaxNumber:  
Practice Location
Address1: 300 LONGWOOD AVE
Address2: BADER 7
City: BOSTON
State: MA
PostalCode: 021155724
CountryCode: US
TelephoneNumber: 6173556610
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 08/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZB0001X60402MAY Allopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine

No ID Information.


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