Provider Demographics
NPI:1679599724
Name:BRUZZESE, JOSEPH DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DOMINIC
Last Name:BRUZZESE
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 1:5116 EVELYN BYRD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3022
Mailing Address - Country:US
Mailing Address - Phone:804-477-6260
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5536
Practice Address - Fax:804-675-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine