Provider Demographics
NPI:1083788202
Name:MOLINELLI, BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:MOLINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2152
Mailing Address - Country:US
Mailing Address - Phone:203-742-1173
Mailing Address - Fax:203-489-3411
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2152
Practice Address - Country:US
Practice Address - Phone:203-742-1173
Practice Address - Fax:203-489-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT033066208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF60854Medicare UPIN