Provider Demographics
NPI:1720550445
Name:DEBORAH BRUNSON MD LLC
Entity Type:Organization
Organization Name:DEBORAH BRUNSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOSZCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-278-6394
Mailing Address - Street 1:234 BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3278
Mailing Address - Country:US
Mailing Address - Phone:203-877-3728
Mailing Address - Fax:203-877-1614
Practice Address - Street 1:234 BROAD ST STE 12044
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3278
Practice Address - Country:US
Practice Address - Phone:203-877-3728
Practice Address - Fax:203-877-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPIOther1659392363