MEDICARE: CHRISTINA MARIE BRUEGGEMANN 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	208000000X	Pediatrics Physician	215834	NY

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	:	1861507998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE BRUEGGEMANN MD

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD
Second Line	:	SUITE 201
City	:	LATHAM
State	:	NY
Zip	:	12110-2442
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 LAKE HILL RD
Second Line	:
City	:	BURNT HILLS
State	:	NY
Zip	:	12027-9507
Country	:	US
Telephone Number	:	518-384-1281
Fax Number	:	518-384-0321

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/06/2007

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