Provider Demographics
NPI:1679029490
Name:CHIASSON, BRUNO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:
Last Name:CHIASSON
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 1:635 E WATERFRONT DR
Mailing Address - Street 2:APT 5304
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-5028
Mailing Address - Country:US
Mailing Address - Phone:786-609-1328
Mailing Address - Fax:
Practice Address - Street 1:2347 FIFTH AVE.
Practice Address - Street 2:UPMC MCKEESPORT LATTERMAN FAMILY HEALTH CENTER
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-673-5504
Practice Address - Fax:412-673-2150
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT212021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine