Provider Demographics
NPI:1992752836
Name:BRUNO, KIMBERLY M (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
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 1:109 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9301
Mailing Address - Country:US
Mailing Address - Phone:802-851-8600
Mailing Address - Fax:877-245-5990
Practice Address - Street 1:109 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9301
Practice Address - Country:US
Practice Address - Phone:802-851-0999
Practice Address - Fax:877-245-5990
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-9641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT080157480OtherTRAVELERS MEDICARE
VT0002074Medicaid
VT00048095OtherBCBS
VT0002074Medicaid
VT080157480OtherTRAVELERS MEDICARE