Provider Demographics
NPI:1336111020
Name:BRUNO-MURTHA, LOU ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LOU ANN
Middle Name:
Last Name:BRUNO-MURTHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1408
Mailing Address - Country:US
Mailing Address - Phone:617-665-1343
Mailing Address - Fax:617-591-4360
Practice Address - Street 1:230 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1408
Practice Address - Country:US
Practice Address - Phone:617-591-4780
Practice Address - Fax:617-591-4360
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70986207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3078116Medicaid
MA472553OtherUS HEALTHCARE
MA728136OtherTUFTS
MA728136OtherTUFTS
MAE78883Medicare UPIN