Provider Demographics
NPI:1104834597
Name:BRUNO BROWN PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:BRUNO BROWN PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-215-5955
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 1210
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-215-5955
Mailing Address - Fax:301-215-5944
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 1210
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-215-5955
Practice Address - Fax:301-215-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01404Medicare PIN
MD351PMedicare PIN