Healthcare Provider Details

I. General information

NPI: 1134158041
Provider Name (Legal Business Name): TERRENCE BUGAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTHROP RD
WALLINGFORD CT
06492-1997
US

IV. Provider business mailing address

900 NORTHRUP RD
WALLINGFORD CT
06492
US

V. Phone/Fax

Practice location:
  • Phone: 203-949-1534
  • Fax:
Mailing address:
  • Phone: 203-949-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number031312
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: