Provider Demographics
NPI:1205836509
Name:KRAUT, BRUCE H (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:KRAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6011
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-0011
Mailing Address - Country:US
Mailing Address - Phone:609-896-0391
Mailing Address - Fax:
Practice Address - Street 1:2500 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1600
Practice Address - Country:US
Practice Address - Phone:609-896-0391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68627173000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1753755-007OtherCIGNA PROVIDER ID
FL593324260OtherTAX ID
FL27289OtherBCBS PROVIDER ID
FL5467014OtherAETNA PROVIDER ID
FL219764OtherAVMED PROVIDER ID
FL378073200Medicaid
FL378073200Medicaid
FLG21223Medicare UPIN