Provider Demographics
NPI:1659463131
Name:BRAITHWAITE, RONALD SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SCOTT
Last Name:BRAITHWAITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:MAILSTOP 11-ACSLG ROOM 215
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-937-4926
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:MAILSTOP 11-ACSLG ROOM 215
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-4926
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073854L207R00000X
CT045182208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine