Provider Demographics
NPI:1396786554
Name:BRUCK, KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:BRUCK
Suffix:
Gender:F
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:P.O. BOX 310032
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06131-0032
Mailing Address - Country:US
Mailing Address - Phone:860-993-5126
Mailing Address - Fax:413-553-6760
Practice Address - Street 1:175 CAPITAL BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3194
Practice Address - Country:US
Practice Address - Phone:860-993-5126
Practice Address - Fax:413-447-8521
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
201300OtherMED A BHMH
20Z300OtherMEDICARE A BHMH SWING BED
102380100OtherMEDICAID BHMH
200051OtherMEDICARE B BHMH
AA105016OtherHARVARD PILGRIM
SX3479OtherMED B BHMH
061408OtherANTHEM
7243065OtherAETNA HMO
102380100OtherMEDICAID BHMH
MEMM911002Medicare PIN
MM9110Medicare PIN
SX3479OtherMED B BHMH