Provider Demographics
NPI:1386085850
Name:BURGDORF BANK OF AMERICA HEALTH CENTER
Entity type:Organization
Organization Name:BURGDORF BANK OF AMERICA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-714-3690
Mailing Address - Street 1:131 COVENTRY ST
Mailing Address - Street 2:2ND FLOOR ADMINISTRATION
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1548
Mailing Address - Country:US
Mailing Address - Phone:860-714-2813
Mailing Address - Fax:860-714-8541
Practice Address - Street 1:131 COVENTRY ST
Practice Address - Street 2:2ND FLOOR ADMINISTRATION
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1548
Practice Address - Country:US
Practice Address - Phone:860-714-2813
Practice Address - Fax:860-714-8541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT FRANCIS HOSPITAL & MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care