Provider Demographics
NPI:1740318286
Name:TOLGE, BRUNO P (MD)
Entity type:Individual
Prefix:
First Name:BRUNO
Middle Name:P
Last Name:TOLGE
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 1:1563 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6022
Mailing Address - Country:US
Mailing Address - Phone:518-377-3742
Mailing Address - Fax:
Practice Address - Street 1:1401 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3009
Practice Address - Country:US
Practice Address - Phone:518-381-9202
Practice Address - Fax:518-381-1182
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10002049OtherCDPHP
NY00373340Medicaid
NY000413015005OtherBS NENY PROVIDER #
NY13106OtherMVP PROVIDER #
NY630N11OtherEMPIRE BC PROVIDER #
NY000413015005OtherBS NENY PROVIDER #
NYB80886Medicare UPIN