Provider Demographics
NPI:1871802900
Name:ROBERT BRUCE TROSS MD PC
Entity type:Organization
Organization Name:ROBERT BRUCE TROSS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:TROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-318-3050
Mailing Address - Street 1:149 DURHAM RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2677
Mailing Address - Country:US
Mailing Address - Phone:203-318-3050
Mailing Address - Fax:203-318-3048
Practice Address - Street 1:149 DURHAM RD
Practice Address - Street 2:SUITE 25
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2677
Practice Address - Country:US
Practice Address - Phone:203-318-3050
Practice Address - Fax:203-318-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022611208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB83386Medicare UPIN