Provider Demographics
NPI:1831189430
Name:BRUUN, SVEND WALTHER (MD)
Entity type:Individual
Prefix:MR
First Name:SVEND
Middle Name:WALTHER
Last Name:BRUUN
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:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:1480 JOHN FITCH HWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-2035
Practice Address - Country:US
Practice Address - Phone:978-342-0044
Practice Address - Fax:978-342-1912
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA031778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2097184Medicaid
MAD82996Medicare UPIN
MA2097184Medicaid