Provider Demographics
NPI:1083679708
Name:DEBIASE, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:DEBIASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 NEWELL RD
Mailing Address - Street 2:SUITE D24
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-582-3235
Mailing Address - Fax:860-582-0692
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:SUITE D24
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-582-3235
Practice Address - Fax:860-582-0692
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT035995207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001359951Medicaid
G42417Medicare UPIN
CT001359951Medicaid