MEDICARE: DR. MELODY ANN BRUCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	144312	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	160011353	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005996464	OTHER	NY	AETNA
3	040426006335	OTHER	NY	FIDELIS
4	10916	OTHER	NY	GHIHMO
5	16153	OTHER	NY	MVP
6	000416033001	OTHER	NY	BLUE SHIELD
7	00040834901	OTHER	NY	UNIVERA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	10000224	OTHER	NY	CDPHP
10	110916	OTHER	NY	WELLCARE
11	52E351	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1568428654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELODY ANN BRUCE M.D.

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD
Second Line	:	SUITE 203
City	:	LATHAM
State	:	NY
Zip	:	12110-2442
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3700

Provider Business Practice Location Address
First Line	:	101 JORDAN RD
Second Line	:	SUITE 200
City	:	TROY
State	:	NY
Zip	:	12180-8343
Country	:	US
Telephone Number	:	518-274-0476
Fax Number	:	518-274-0497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/16/2013

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Directions to “ DR. MELODY ANN BRUCE M.D.” Practice Location

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