Provider Demographics
NPI:1972580983
Name:COTUGNO, BRUCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:COTUGNO
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 1:1025 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2119
Mailing Address - Country:US
Mailing Address - Phone:724-229-6195
Mailing Address - Fax:724-229-6199
Practice Address - Street 1:1025 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2119
Practice Address - Country:US
Practice Address - Phone:724-229-6195
Practice Address - Fax:724-229-6199
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049746L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018725540002Medicaid
PAF52779Medicare UPIN
PA0018725540002Medicaid