Provider Demographics
NPI:1710918032
Name:BRANDT, DEBRA SCHWAB (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SCHWAB
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-489-1799
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-482-5384
Practice Address - Fax:860-496-4951
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000418207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000418OtherLICENSE
CT001004184Medicaid
06-1088532OtherTAX ID #
CT23402OtherCONTROLLED SUBSTANCE
BB5816434OtherDEA
F92638Medicare UPIN
C00633Medicare ID - Type UnspecifiedMR GROUP #
110007161Medicare ID - Type Unspecified
CTP00152091Medicare PIN
CT23402OtherCONTROLLED SUBSTANCE