Provider Demographics
NPI:1346202371
Name:EBRIGHT, DEENA RACHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEENA
Middle Name:RACHEL
Last Name:EBRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEENA
Other - Middle Name:RACHEL
Other - Last Name:FORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:36 GROVE ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5329
Mailing Address - Country:US
Mailing Address - Phone:203-966-6305
Mailing Address - Fax:203-966-4618
Practice Address - Street 1:36 GROVE ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5329
Practice Address - Country:US
Practice Address - Phone:203-966-6305
Practice Address - Fax:203-966-4618
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH10642Medicare UPIN
MD977502100Medicaid
MDK453A595Medicare ID - Type Unspecified