Healthcare Provider Details

I. General information

NPI: 1871802900
Provider Name (Legal Business Name): ROBERT BRUCE TROSS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DURHAM RD SUITE 25
MADISON CT
06443-2677
US

IV. Provider business mailing address

149 DURHAM RD SUITE 25
MADISON CT
06443-2677
US

V. Phone/Fax

Practice location:
  • Phone: 203-318-3050
  • Fax: 203-318-3048
Mailing address:
  • Phone: 203-318-3050
  • Fax: 203-318-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number022611
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number022611
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT BRUCE TROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 203-318-3050