MEDICARE: BRETT L WASSERLAUF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	041794	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275597882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT L WASSERLAUF MD

Provider Business Mailing Address
First Line	:	35 JOLLEY DR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3062
Country	:	US
Telephone Number	:	860-242-3000
Fax Number	:	860-286-9547

Provider Business Practice Location Address
First Line	:	35 JOLLEY DR
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3062
Country	:	US
Telephone Number	:	860-242-3000
Fax Number	:	860-286-9547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/18/2016

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