Provider Demographics
NPI:1285029892
Name:CHACON-MORENO, BRENDA EDITH (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:EDITH
Last Name:CHACON-MORENO
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 1:132 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7831
Mailing Address - Country:US
Mailing Address - Phone:203-794-1979
Mailing Address - Fax:203-794-1796
Practice Address - Street 1:100 RESERVE RD STE A4
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5267
Practice Address - Country:US
Practice Address - Phone:203-794-1979
Practice Address - Fax:203-794-1796
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT061437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty