Provider Demographics
NPI:1144266495
Name:BETTE, MARIANNE (MD EAAFP)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:BETTE
Suffix:
Gender:F
Credentials:MD EAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAIN ST N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SOUTHBURG
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-267-5560
Mailing Address - Fax:203-267-5561
Practice Address - Street 1:77 MAIN STREET NORTH
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-267-5560
Practice Address - Fax:203-267-5561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48304Medicare UPIN