Provider Demographics
NPI:1568428654
Name:BRUCE, MELODY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3700
Practice Address - Street 1:101 JORDAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8343
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY144312207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005996464OtherAETNA
NY160011353OtherRAILROAD MEDICARE
NY040426006335OtherFIDELIS
NY10916OtherGHIHMO
NY16153OtherMVP
NY000416033001OtherBLUE SHIELD
NY00040834901OtherUNIVERA
NY00731659Medicaid
NY10000224OtherCDPHP
NY110916OtherWELLCARE
NY52E351OtherBLUE CROSS
NY16153OtherMVP
NY040426006335OtherFIDELIS
NY39622DMedicare ID - Type Unspecified