Healthcare Provider Details

I. General information

NPI: 1578550430
Provider Name (Legal Business Name): JULIA J BRUCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WHITEHALL RD
ROCHESTER NH
03867-3226
US

IV. Provider business mailing address

15 WHITEHALL RD
ROCHESTER NH
03867-3226
US

V. Phone/Fax

Practice location:
  • Phone: 603-335-8195
  • Fax: 603-330-0098
Mailing address:
  • Phone: 603-335-8195
  • Fax: 603-330-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number9077
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number014091
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number212696
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0420008160
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberM5487
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: