Provider Demographics
NPI:1154327765
Name:BRUNGO, JOHN A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:BRUNGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3616
Mailing Address - Country:US
Mailing Address - Phone:412-278-5100
Mailing Address - Fax:412-278-5105
Practice Address - Street 1:4721 MCKNIGHT RD
Practice Address - Street 2:SUITE 209N
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3415
Practice Address - Country:US
Practice Address - Phone:412-366-5550
Practice Address - Fax:412-366-7044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD028567-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006720020001Medicaid
PA0006720020001Medicaid