Healthcare Provider Details

I. General information

NPI: 1609920974
Provider Name (Legal Business Name): CHRISTOPHER J BRUNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST 2ND FL
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

1601 CHERRY ST SUITE 11511
PHILADELPHIA PA
19102-1320
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-2530
  • Fax:
Mailing address:
  • Phone: 215-255-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD422247
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD422247
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: