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General NPI Number Information
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NPI Number | 1659340651
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Entity Type | Individual
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Provider Name | NERMINA BUKALO MD
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-540-6595
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Fax |
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Provider Business Mailing Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-540-6595
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 224430
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 048166
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License Number State | CT
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