Provider Demographics
NPI:1053338657
Name:DZIURA, BRUCE R (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:DZIURA
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 789
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0789
Mailing Address - Country:US
Mailing Address - Phone:413-509-1000
Mailing Address - Fax:413-509-1003
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2301
Practice Address - Country:US
Practice Address - Phone:413-748-9513
Practice Address - Fax:413-748-6844
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44997207ZC0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000020248OtherBMC-HEALTHNET
MA11988OtherHEALTH NEW ENGLAND
MA449970OtherCONNECTICARE
MA6182151Medicaid
MAJ03496OtherBLUE CROSS OF MA
MA351643OtherHARVARD PILGRIM
MA044997OtherTUFTS
MA98149201OtherNETWORK HEALTH
NY02681827Medicaid
MA220031586OtherRAILROAD MEDICARE
MA0024836OtherNEIGHBORHOOD HEALTH PLAN
NH30206819Medicaid
MA220031586OtherRAILROAD MEDICARE
NH30206819Medicaid