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General NPI Number Information
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NPI Number | 1417122946
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Entity Type | Individual
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Provider Name | CHARLES BRUCE-TAGOE MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 3272 MAIN ST
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City | STRATFORD
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State | CT
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Zip | 06614-4819
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Country | US
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Telephone | 203-386-0366
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Fax | 203-380-1495
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Provider Business Mailing Address
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Address Line | 2660 MAIN ST STE 216
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5301
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Country | US
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Telephone | 203-386-0366
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Fax | 203-380-1495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 47946
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License Number State | CT
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