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General NPI Number Information
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NPI Number | 1659153005
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Entity Type | Organization
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Legal Business Name | BRIDGE DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/21/2023
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Provider Practice Location Address
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Address Line | 22 EAGLE RD
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City | DANBURY
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State | CT
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Zip | 06810-4129
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Country | US
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Telephone | 203-980-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 S 204TH ST STE 134
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City | ELKHORN
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State | NE
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Zip | 68022-2880
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN MICHAEL TROWBRIDGE
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Credential | MD
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Telephone | 203-980-4052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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