Provider Demographics
NPI:1174657829
Name:MAYER, DEBORAH A (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MAYER
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 1:7 MAYFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2632
Mailing Address - Country:US
Mailing Address - Phone:203-803-9132
Mailing Address - Fax:203-255-8087
Practice Address - Street 1:131 KINGS HWY N STE 2
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2429
Practice Address - Country:US
Practice Address - Phone:203-557-8347
Practice Address - Fax:203-557-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB96928Medicare UPIN