Healthcare Provider Details

I. General information

NPI: 1174510267
Provider Name (Legal Business Name): RAMON BRUGADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E GENESEE ST STE 300
SYRACUSE NY
13210-1892
US

IV. Provider business mailing address

1000 E GENESEE ST STE 300
SYRACUSE NY
13210-1892
US

V. Phone/Fax

Practice location:
  • Phone: 315-471-1044
  • Fax: 315-474-4312
Mailing address:
  • Phone: 315-471-1044
  • Fax: 315-474-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2313641
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number231364
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number231364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: