Provider Demographics
NPI:1124068184
Name:BRUNO, MARIA DOLORES (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:BRUNO
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 1:3723 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-675-5000
Mailing Address - Fax:716-674-8756
Practice Address - Street 1:3723 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-675-5000
Practice Address - Fax:716-674-8756
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204381207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180043359OtherRR MEDICARE
00020518101OtherUNIVERA
005256532OtherBCBS OF WNY
0810673OtherIHA
CC7354Medicare ID - Type Unspecified
H10122Medicare UPIN