Provider Demographics
NPI:1225017858
Name:BRUNO, CRAIG GEORGE (PA)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:GEORGE
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8125
Mailing Address - Country:US
Mailing Address - Phone:252-756-5545
Mailing Address - Fax:252-756-5545
Practice Address - Street 1:3121 MOSELEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4245
Practice Address - Country:US
Practice Address - Phone:252-758-4455
Practice Address - Fax:252-758-6742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS58590Medicare UPIN
NC2745912Medicare ID - Type Unspecified