Provider Demographics
NPI:1326002247
Name:BRUNET, CRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:BRUNET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2342
Mailing Address - Country:US
Mailing Address - Phone:203-318-5200
Mailing Address - Fax:203-318-5203
Practice Address - Street 1:11 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2342
Practice Address - Country:US
Practice Address - Phone:203-318-5200
Practice Address - Fax:203-318-5203
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT30258174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11023452OtherRAILROAD MEDICARE
CT660000031Medicare ID - Type Unspecified
CTF71642Medicare UPIN