Provider Demographics
NPI:1104075084
Name:NADJMI, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:NADJMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BORZOO
Other - Middle Name:JOHAN
Other - Last Name:NADJMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 CHRISTOPHER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4946
Mailing Address - Country:US
Mailing Address - Phone:401-723-7216
Mailing Address - Fax:401-723-7216
Practice Address - Street 1:5 CHRISTOPHER DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4946
Practice Address - Country:US
Practice Address - Phone:401-723-7216
Practice Address - Fax:401-723-7216
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD04790208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology