Provider Demographics
NPI:1417122946
Name:BRUCE-TAGOE, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BRUCE-TAGOE
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 1:2660 MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5301
Mailing Address - Country:US
Mailing Address - Phone:203-386-0366
Mailing Address - Fax:203-380-1495
Practice Address - Street 1:3272 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4819
Practice Address - Country:US
Practice Address - Phone:203-386-0366
Practice Address - Fax:203-380-1495
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT47946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine