=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528074192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER DENIS BRUNO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1499 CHAIN BRIDGE RD SUITE 100
-----------------------------------------------------
City | MCLEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-442-8301
-----------------------------------------------------
Fax | 703-790-1773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1499 CHAIN BRIDGE RD SUITE 100
-----------------------------------------------------
City | MCLEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-442-8301
-----------------------------------------------------
Fax | 703-790-1773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101031799
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------