Provider Demographics
NPI:1700922218
Name:BULGER, CHRISTOPHER M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
Last Name:BULGER
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 1:479 BUCKLAND RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3739
Mailing Address - Country:US
Mailing Address - Phone:860-288-7244
Mailing Address - Fax:833-418-1902
Practice Address - Street 1:479 BUCKLAND RD FL 2
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3739
Practice Address - Country:US
Practice Address - Phone:860-288-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043351208600000X, 2086S0129X
CT043551202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1700922218Medicaid
CT1700922218Medicaid
CTP00918490Medicare PIN
CTDR2994Medicare PIN
CTH97987Medicare UPIN
CTD100037356Medicare PIN
CT770000077Medicare PIN