Healthcare Provider Details

I. General information

NPI: 1992823710
Provider Name (Legal Business Name): DAVID ANTHONY BRUNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MARSHALL ST
RICHMOND VA
23298
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4104
  • Fax: 804-828-0854
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101237624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: