Provider Demographics
NPI:1609859958
Name:WATROUS, BRUCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:WATROUS
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 1:607 NORTH AVENUE, DOOR 17
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-942-0606
Mailing Address - Fax:781-942-4674
Practice Address - Street 1:607 NORTH AVENUE, DOOR 17
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-942-0606
Practice Address - Fax:781-942-4674
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72517207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3063208Medicaid
MAC89803Medicare UPIN